Unilateral Distribution Research Articles

Differentiating Neuropathic and Inflammatory Heel Pain: Clinical Evaluation and Diagnostic Utility of the Sural Nerve Ankle Block

Background: Heel pain is a prevalent issue with diverse aetiologies, including neuropathic and inflammatory causes, each requiring different therapeutic approaches. This study aims to differentiate between these types of heel pain using clinical evaluation and the sural nerve ankle block as a diagnostic tool. Methods: This prospective analytical study was conducted in the Department of Orthopaedics at Krishna Institute of Medical Sciences, Karad, India, over an 18-month period. A total of 50 patients aged 18 years and above presenting with heel pain were included. After obtaining informed consent, patients underwent clinical assessment, including palpation, Windlass test, Gore’s sign, and Visual Analogue Scale (VAS) scoring. A sural nerve block was administered to assess its diagnostic value, and VAS scores were recorded immediately and at various follow-up intervals. Results: Neuropathic pain was characterized by burning sensations, persistence throughout the day, unilateral distribution, and positive Gore’s sign, whereas inflammatory pain showed sharp morning pain, bilateral distribution, and positive Windlass test. Immediately post-block, neuropathic pain patients showed significant pain reduction, which persisted over time, while inflammatory pain patients exhibited minimal improvement. The sural nerve block proved effective in diagnosing neuropathic pain. Conclusion: Clinical assessment combined with the sural nerve block can effectively distinguish neuropathic from inflammatory heel pain. Neuropathic pain patients experienced significant relief post-block, confirming its utility as both a diagnostic and therapeutic tool in neuropathic cases.

Application of electronic laryngoscope combined with narrow band imaging endoscope and its classification in the diagnosis of vocal cord leukoplakia

Objective:To investigate the clinical value of electronic laryngoscope combined with narrow band imaging（NBI） endoscope and its classification in the diagnosis of vocal cord leukoplakia. Methods:A retrospective analysis was performed on 115 cases of patients treated in the Department of Otolaryngology, Head and Neck Surgery, Nanjing Drum Tower Hospital from September 2020 to November 2022. All 115 cases were diagnosed with vocal cord leukogramma using the electronic laryngoscopy and narrow band imaging endoscopy, followed by pathological examination in the outpatient tissue biopsy. The morphological characteristics of vocal cord leukoplakia and the correlation between narrow band imaging classification and pathological results were investigated. Results:Among 115 cases of vocal cord leukoplakia, 46 cases（40.00%） were diagnosed as benign lesions. Low grade intraepithelial neoplasia occurred in 29 cases（25.22%）. High-grade intraepithelial neoplasia（including carcinoma in situ） occurred in 22 cases（19.13%）. Invasive carcinoma（including suspected invasive carcinoma） was found in 18 cases（15.65%）. There were no statistical differences in the unilateral and bilateral distribution of vocal cord leukoplakia and pathological results（P>0.05）, but there were statistical differences in the size, thickness, lesion uniformity, clear boundary, pre-invasion commissure, symmetry,age over 55 years old, morphological classification, NBI classification and pathological results distribution（P<0.05）. The two-by-two comparison among the three groups of morphological classification（flat type, raised type, rough type） showed that P<0.017 was only compared between flat type and rough type, and P>0.017 was compared between the other two groups. The pairwise comparison among the three groups of NBI classification（Ⅲ, Ⅳ, Ⅴ） was statistically significant（P<0.017）. There was a high correlation between NBI classification and pathological diagnosis, and the correlation coefficient was 0.705（P<0.05）. The risk of high intraepithelial neoplasia and cancerization in type Ⅳ was 9.125 times higher than that in type Ⅲ, and the risk of high intraepithelial neoplasia and cancerization in type Ⅴ was 271.078 times higher than that in type Ⅲ. The area under the curve of morphological classification and NBI classification were 0.672 and 0.896, respectively. Conclusion:There is a high match and correlation between NBI classification and pathological diagnosis. Electronic laryngoscope combined with narrow band imaging endoscope has a high diagnostic value for vocal cord leukoplakia, and a strong predictive ability for malignant leukoplakia.

Comparison of a fixed dose of 0.15% Hypobaric and 0.5% Hyperbaric Bupivacaine for shortterm unilateral lower limb orthopedic surgeries.Retrospective study with two videos

Background: Unilateral spinal anesthesia in orthopedic surgery of a limb has its advantages, especially in patients undergoing outpatient basis surgeries. Low dose, slow speed of administration and remaining in lateral decubitus for a certain period facilitate unilateral distribution in spinal anesthesia. Isobaric solutions of local anesthetics are not suitable for this type of anesthesia. Hypobaric and hyperbaric solutions of bupivacaine were compared in unilateral spinal anesthesia in patients undergoing orthopedic surgeries of one limb on an outpatient basis. Methods: Retrospective study carried out between 2002 and 2020 with 497 patients were randomly divided into two groups to receive 6 mg of 0.15% hypobaric bupivacaine or 6 mg of 0.5% hyperbaric bupivacaine. The solutions were administered in the L3-L4 space with the patient in the left lateral decubitus and remaining in this position for 15 minutes. Sensitive anesthesia was evaluated by the pin prick test. Motor blockade was determined by the modified Bromage scale. Both blockades were compared with the opposite side and among themselves. Results: There was a significant difference between the side of the surgery and the opposite side in all two groups at 15 minutes, but the frequency of unilateral spinal anesthesia was 90.9% with the 0.15% hypobaric bupivacaine versus 93.2% with the 0.5% hyperbaric bupivacaine. Patients did not develop any hemodynamic changes. Post puncture headache and transitory neurological symptoms were not observed. Conclusion: Spinal anesthesia with hypobaric and hyperbaric solutions present a higher frequency of unilateral anesthesia, without cardiocirculatory alteration, and patient satisfaction in remaining with a limb without anesthesia.

Neuroradiologic, Clinical, and Genetic Characterization of Cerebellar Heterotopia: A Pediatric Multicentric Study.

Cerebellar heterotopia (CH) is a neuroradiologic abnormality that is poorly reported and investigated in the literature. It can be observed as an isolated finding, but it has been mainly reported in the context of cerebellar dysgenesis and syndromic conditions. This study aims to provide a comprehensive neuroradiologic, clinical, and genetic characterization of a cohort of pediatric patients with CH. Patients with a diagnosis of CH were systematically selected from the neuroimaging databases of the 4 Italian centers participating in this retrospective study. For each patient, information regarding demographic, clinical, genetic, and neuroradiologic data was collected. Thirty-two pediatric patients were recruited and subdivided into 2 groups: patients with isolated CH and/or cerebellar malformations (n = 18) and patients with CH associated with cerebral malformations (n = 14). Isolated CH consistently showed a peripheral subcortical localization in the inferior portion of cerebellar hemispheres, with either unilateral or bilateral distribution. Ten patients belonging to the second group had a diagnosis of CHARGE syndrome, and their nodules of CH were mainly but not exclusively bilateral, symmetric, located in the peripheral subcortical zone and the inferior portion of the cerebellar hemispheres. The remaining 4 patients of the second group showed either bilateral or unilateral CH, located in both the peripheral cortex and deep white matter and the superior and inferior portions of cerebellum. Patients with isolated CH showed a high prevalence of language development delay; neurodevelopmental disorders were the most represented clinical diagnoses. Recurring features were behavioral problems and motor difficulties. A conclusive genetic diagnosis was found in 18/32 patients. We found distinctive neuroradiologic patterns of CH. Genetic results raise the possibility of a correlation between cerebellar morphologic and functional developmental disruption, underscoring the importance of CH detection and reporting to orient the diagnostic path.

Lichen striatus: a review.

Lichen striatus (LS) is an acquired blaschkitis, with typical linear and unilateral distribution. It occurs mainly in children and is self-resolving, yet its etiopathogenesis remains widely unknown. A review of the literature on LS cases was performed using the keyword "lichen striatus" to retrieve all relevant articles through PubMed and Google Scholar. A total of 27 articles describing 440 LS patients were included in the present review. Mean age of patients was 3.8 years; male: female: ratio was 1:1.9. The present review confirms LS as a primarily pediatric condition, mainly affecting females. Dysregulation of the immune system might be involved in its pathogenesis, with cytotoxic T-cells attacking mosaic keratinocytes after loss of immune tolerance. The review confirms LS is mainly diagnosed clinically (80%) based on its clinical characteristics: erythematous (70%) or hypopigmented (24%) papules, distributed along the lines of Blashko. The benignity of this clinical entity is suggested by the rather short duration of disease (9.5 months on average) and by the uncommonness of therapy, adopted in only 20% of cases, and when needed, administered topically. This review examines the complexities of LS but acknowledges limitations in data sources and calls for further research.

Segmental vitiligo distribution follows the underlying arterial blood supply territory: a hypothesis based on anatomo-clinical, pathological and physio-pathological studies.

Segmental vitiligo (SV) is a subset of vitiligo typically characterized by its unilateral distribution. The pathogenesis of SV remains unclear, and until now the two main patterns proposed for SV have lacked biological support. This calls for a new approach. Use data obtained from anatomo-clinical, pathological, and physio-pathological studies to formulate a new hypothesis on segmental vitiligo distribution and its pathogenesis. Using transparent templates of local arterial blood supply, we evaluated anatomical correspondence (AC) in 140 SV lesions according to the number of SV lesions that fit within the corresponding arterial blood-supply areas. SV lesions were graded as 1 (moderate: AC < 50%), 2 (good: AC > 50%), or 3 (excellent: AC of all lesions). To support this anatomical investigation, we searched for complementary assessments according to the activity of SV lesions. Arterial and periarterial network impairment and inflammatory infiltration were histologically studied using nerve growth factor (NGF) and CD4 and CD8 monoclonal antibodies. Increased blood flow of the underlying arteries was also investigated using thermography and ultrasonography. We recruited 140 patients with a sex ratio of 0.8 and mean age 26.13 years. Localizations: head and neck 84.28%; trunk 6.42%; upper limb 5%; genital areas 2.14%; lower limb 1.42%. The AC of each SV lesion with the underlying artery blood supply territory was rated as 72% excellent; 16% good; and 12% moderate. Histologically (40 patients), we found some periarterial network impairments. Thermal asymmetry was significantly associated with active SV (p < 0.001). We hypothesized that SV distribution corresponds to the underlying artery blood-supply territory.

Does portal vein anatomy influence intrahepatic distribution of metastases from colorectal cancer?

Other than location of the primary colorectal cancer (CRC), a few factors are known to influence the intrahepatic distribution of colorectal cancer liver metastases (CRLM). We aimed to assess whether the anatomy of the portal vein (PV) could influence the intrahepatic distribution of CRLM. Patients with CRLM diagnosed between January 2018 and December 2022 at two tertiary centers were included and imaging was reviewed by two radiologists independently. Intra-operator concordance was assessed according to the intraclass correlation coefficient (ICC). The influence of the diameter, angulation of the PV branches and their variations on the number and distribution of CRLM were compared using Mann-Whitney, Kruskal-Wallis, Pearson's Chi-square and Spearman's correlation tests. Two hundred patients were included. ICC was high (> 0.90, P < 0.001). Intrahepatic CRLM distribution was right-liver, left-liver unilateral and bilateral in 66 (33%), 24 (12%) and 110 patients (55%), respectively. Median number of CRLM was 3 (1-7). Type 1, 2 and 3 portal vein variations were observed in 156 (78%), 19 (9.5%) and 25 (12%) patients, respectively. CRLM unilateral or bilateral distribution was not influenced by PV anatomical variations (P = 0.13), diameter of the right (P = 0.90) or left (P = 0.50) PV branches, angulation of the right (P = 0.20) or left (P = 0.80) PV branches and was independent from primary tumor localisation (P = 0.60). No correlations were found between CRLM number and diameter (R: 0.093, P = 0.10) or angulation of the PV branches (R: 0.012, P = 0.83). PV anatomy does not seem to influence the distribution and number of CRLM.

Topographic and temporal patterns of dyskinesia in multiple system atrophy with predominant parkinsonism

BackgroundAlthough dyskinesia is well recognized in Parkinson's disease, it is generally under acknowledged in multiple system atrophy (MSA). Reported cases of dyskinesia primarily manifest in patients with MSA with predominant parkinsonism (MSA-P), and characteristically present as orofacial dystonia. However, we have observed other manifestations of dyskinesia in our clinical practice. The current report aims to present the specific manifestations of dyskinesia in MSA-P, with videos. MethodsWe enrolled six patients with MSA-P with dyskinesia from Xuanwu Hospital. Of these, four had clinically established MSA-P and two had clinically probable MSA-P according to the 2022 Movement Disorder Society criteria for MSA diagnosis. All six patients underwent an acute levodopa challenge test, and videos were recorded during the process. ResultsDyskinesia had a unilateral distribution in four patients. Three patients presented with peak-dose orofacial dystonia; of these, two were associated with blepharospasm and two were associated with limb dystonia. In addition, we observed that one patient had peak-dose distal lower limb dystonia with upper limb chorea, one patient had wearing-off dystonia of the eyelids, and one patient had diphasic generalized chorea mimicking that of Parkinson's disease. ConclusionsIn addition to orofacial dystonia, the topographic patterns of dyskinesia in MSA-P can manifest as limb dystonia, blepharospasm, and generalized chorea. Moreover, the temporal patterns of dyskinesia in MSA-P can be peak-dose, wearing-off, or diphasic.

Cordotomy for pain control and opioid reduction in cancer patients: A cancer center 11-year experience

BackgroundPercutaneous lateral cervical cordotomy (PLCC) is a treatment option for predominantly nociceptive pain of oncological origin that is refractory to conservative methods, with unilateral distribution, particularly in the lower trunk or lower limbs of patients with a life expectancy of less than one year. ObjectiveThe aim of this study was to assess the analgesic efficacy and opioid utilization alteration in patients undergoing PLCC. MethodsWe retrospectively collected data from patients undergoing PLCC between 2011 and 2021 at the AC Camargo Cancer Center in São Paulo, Brazil. ResultsSixty-three patients and their respective surgical outcomes were analyzed. The mean preoperative pain intensity, as assessed by the mean numerical rating scale (NRS), was 8.4 (range: 4–10), while postoperatively, it decreased to 0.78 (range: 0–8). Lower postoperative NRS scores were observed for pain in the lower limbs and abdomen compared to the lower thorax. The mean preoperative oral morphine equivalent (OME) consumption was 231.0 mg (range: 30.0–1015.2). At 30 days postoperative, the mean consumption of OME was 120.2 mg (range: 0.0–705.0). Twelve months after surgery, the average consumption of OME was 98.3 mg (range: 0.0–396.0). ConclusionPLCC is a valuable therapeutic intervention for patients experiencing cancer pain that is unresponsive to conservative treatments. The anticipated analgesic outcomes are generally favorable, particularly in cases where the pain is localized unilaterally in the abdomen or lower body segments.

Nevus Unius Lateris (NUL) in a Theree-Year-Old Child Treated by Tretinoin 0.025%, Desoxymethasone 0.25%, and Urea 20% Cream

Background: Linear verrucous epidermal nevus is the most frequent variant of the epidermal nevus classification. Linear verrucous epidermal nevus is characterized by the proliferation of epithelium arranged in a configuration that follows Blaschko's line. Nevus unius lateris (NUL) is a variant of the verrucous epidermal nevus, which has a unilateral distribution of lesions. Lesions are usually found at birth or in the first year of life as brown to grey verrucous papules or papillomatous plaques. The management of NUL is challenging as the results are varied and there is a high risk of recurrence. Purpose: to report a case of NUL and its management, especially in children. Case: A 3-year-old girl presented with brownish spots and multiple small lumps on the left buttock that have extended to the left leg since she was 9-days-old. On dermatologic examination, there were numerous hyperpigmented verrucous papules and plaques along the Blaschko line over the affected area. In this case, the diagnosis of NUL, is based on clinical symptoms and dermoscopy examination showed multiple large brown oval or round structures with hyperpigmented brown border. The patient was treated with combination topical therapy of tretinoin 0.025%, corticosteroid desoxymethasone 0.25%, and urea 20% cream, and the lesion improved within four weeks. Discussion: Epidermal nevus is often cosmetically disturbing. The treatment is still challenging and various, including surgical and non-surgical, but none is ideal and could potentially recur over months or years. dst.

Clinical and epidemiological profile of herpes zoster cases and its complications: A prospective study

Background: The varicella-zoster virus, which is known to lie dormant in the dorsal root ganglia after primary chickenpox infection or immunization, and in rare instances, intrauterine infection, is the source of the common viral infection known as herpes zoster (HZ). In healthy people, the illness usually goes away on its own, but in severely immunocompromised patients, it can cause persistent debilitation through multi-dermatomal, severe, vesiculo-pustular, nodular, crusted, and ecthymatous manifestations. Aims and Objectives: The aim of this study was to better understand the clinical profile and epidemiological patterns of HZ and various postherpetic complications. Materials and Methods: A prospective cross-sectional study was conducted at a tertiary care hospital in Karnataka for 24 months during August 2013–August 2015. Seventy-five patients with HZ and postherpetic complications attending the dermatology outpatient department were included in the study. Pre-existing comorbidities and patient details were recorded. The Hayes and Patterson Visual Analog Scale (VAS) was used to record the kind, duration, and intensity of the pain. Results: The current cross-sectional study was done in a tertiary care hospital, and a total of 75 patients were considered for the study. The youngest patient was a 12-year-old male and the eldest patient was a 90-year-old male. The average age of patients was 52.45 ± 12.5 years. Cutaneous examination showed erythema (84%) and vesicles (84%). The intensity of pain was classified based on the VAS. About 54.6% of patients had a moderate degree of pain. Conclusion: Acute vesicles with erythema and radicular pain with a unilateral dermatomal distribution are the most typical presentation of HZ infection, and they are most frequently seen in the thoracic area.

Optimizing percutaneous vertebroplasty: extra-facet puncture for osteoporotic vertebral compression fractures

PurposeTo assess the safety and efficacy of the extra-facet puncture technique applied in unilateral percutaneous vertebroplasty (PVP) for treating osteoporotic vertebral compression fractures.MethodsDemographics (age, gender, body mass index and underlying diseases) were recorded for analyzing. Visual analog scale (VAS) and Oswestry Disability Index (ODI) scores as well as their corresponding minimal clinically important difference (MCID) were used to evaluate clinical outcomes. The segmental kyphotic angle, the vertebral compression ratio and bone cement distribution pattern were evaluated by the plain radiographs. The facet joint violation (FJV) was defined by the postoperative computed tomography scan. Binary logistic regression analysis was performed to investigate relationships between multiple risk factors and residual back pain.ResultsVAS and ODI scores in both traditional puncture group and extra-facet puncture group were significantly decreased after PVP surgery (p < 0.05). However, no significant difference was observed between the two groups according to VAS and ODI scores. The proportion of patients achieving MCID of VAS and ODI scores was higher in extra-facet puncture group as compared to traditional puncture group within a month (p < 0.05). Finally, multivariate logistic regression analysis showed that FJV (odds ratio 16.38, p < 0.001) and unilateral bone cement distribution (OR 5.576, p = 0.020) were significant predictors of residual back pain after PVP surgery.ConclusionsExtra-facet puncture percutaneous vertebroplasty can decrease the risk of FJV and it also has the advantage of more satisfied bone cement distribution.

CBCT Based Evaluation of the Anatomical Variation of Retromolar Canal in A Sample of Egyptian Population. A Retrospective Study

The goal of this study is to estimate the prevalence of the retromolar in the Egyptian population and to enhance the allocation of the retromolar canals and foramina. Methodology: Using a Newtom Giano HR CBCT system, radiographic evaluation of 250 CBCT scans was performed. According to the manufacturer's guidelines, multiple FOVs were used with the same voxel size (0.3 mm) to produce distinct scans for different patient sizes. The presence of retromolar canal was checked for, using the CBCT scans. Linear measurements were made from the retromolar foramen to the mandibular foramen in an anteroposterior and a mediolateral directions, as well as to the lower second and third molars, and their courses was divided into three basic classes. Results: In this study, retromolar canal was absent in sides 207 (82.8%) while was presented in 43 (17%), absence of retromolar canal was significantly higher than its presence as P&lt;0.0001. Regarding distribution, bilateral side (16.3%) was significantly lower than unilateral distribution (83.7%) as P&lt;0.0001. In class distribution, class A (70%) was significantly the highest, while class C (6%) was significantly the lowest. Conclusion: The prevalence of retromolar canal in the Egyptian population is 17%. When evaluating the retromolar region to identify the presence of the retromolar canal and retromolar foramen to prevent problems after various dental surgical procedures, the use of CBCT is crucial.

Unequal Cerebral Magnetic Resonance Imaging Changes in Perinatal Hypoxic Ischemic Injury of Term Neonates.

Perinatal hypoxic ischemic injury (HII) has a higher prevalence in the developing world. One of the primary concepts for suggesting that an imaging pattern reflects a global insult to the brain is when the injury is noted to be bilateral and symmetric in distribution. In the context of HII in term neonates, this is either bilateral symmetric ( a ) peripheral/watershed (WS) injury or ( b ) bilateral symmetric basal-ganglia-thalamus (BGT) pattern, often with the peri-Rolandic and hippocampal injury. Unilateral, asymmetric, or unequal distribution of injury may therefore be misdiagnosed as perinatal arterial ischemic stroke. We aimed to determine the prevalence of unequal cerebral injury in HII, identify patterns, and determine their relationship with existing classification of HII. Review of brain magnetic resonance imaging from a database of children with HII. Reports with any unequal pattern of injury were included and further classified as a unilateral, bilateral asymmetric, or symmetric but unequal degree pattern of HII. A total of 1213 MRI scans in patients with a diagnosis of HII revealed 156 (13%) with unequal involvement of the hemispheres: unilateral in 2 of 1213 (0.2%) (involvement only in the WS), asymmetric in 48 of 1213 (4%) (WS in 6 [0.5%], BGT in 4 [0.3%], and combined BGT and WS in 38 [3.1%]), and bilateral symmetric but unequal degree in 106 of 1213 (8.7%) (WS in 20 [1.6%], BGT in 17 [1.4%], and combined BGT and WS in 69 [5.7%]). The majority of children with cerebral palsy due to HII demonstrate a characteristic bilateral symmetric pattern of injury. In our study, 13% demonstrated an unequal pattern. Differentiation from perinatal arterial ischemic stroke, which is mostly unilateral and distributed typically in the middle cerebral artery territory, should be possible and recognition of the typical BGT or WS magnetic resonance imaging patterns should add confidence to the diagnosis, in such scenarios.

Clinical and CT diagnosis of 50 cases of Chlamydia psittaci pneumonia.

This is a retrospective cross-sectional study aiming to explore the clinical and imaging manifestations of Chlamydia psittaci pneumonia (CPP), thus improving its diagnosis, guiding its early clinical treatment, and reducing its mortality rate. Fifty cases of CPP diagnosed by hospitals across the country with metagenomics next-generation sequencing (mNGS) from January 2019 to March 2021 were collected. Its clinical symptoms, laboratory test results, and computed tomography (CT) features were discussed. Forty patients had a history of poultry exposure; 37 experienced respiratory symptoms, 48 had a fever, 14 experienced gastrointestinal symptoms, and 12 experienced neurological symptoms; 34 patients had normal blood cell counts, 49 patients had elevated C-reactive protein, and 24 showed decreased serum sodium. Imaging manifestations: (I) Distribution: lesions were limited to a single lung in 31 patients, lesions were distributed in bilateral lungs in 19 patients; (II) Signs: 37 patients developed the "fine mesh sign". Necrosis, cavity and "tree-in-bud" were not observed. Pleural effusion occurred in 33 patients, mediastinal lymphadenopathy in 18, and splenomegaly in 15 patients. Patients with CPP often have a history of poultry exposure and present with fever and increased C-reactive protein. White blood cells may be slightly increased or completely normal. Hyponatremia may occur in some patients, and multiple systems may be clinically involved. The imaging can show lesions with unilateral or bilateral lung distribution and a rapid progression. Both the lung parenchyma and the interstitium are involved. Fine mesh sign is the most common sign. Necrosis, cavitation, and tree-in-bud signs are not observed. In conclusion, imaging examinations are helpful for the early diagnosis of this disease and the evaluation of the treatment effect.

Linear Depigmented Macules and Patches in an Elderly Man

The development of immune checkpoint inhibitors such as programmed cell-death receptor 1 (PD-1) antagonists has rapidly advanced chemotherapy within the last several decades. PD-1 targeted immunotherapy drugs like pembrolizumab, ipilimumab, nivolumab, and durvalumab have known associations with several immune-mediated dermatological reactions. We report a case in which an elderly male experienced segmental vitiligo after use of durvalumab therapy for small cell lung cancer. Distinct from non-segmental vitiligo, segmental vitiligo presents in a unilateral blaschkoid distribution and typically does not cross the midline. To our knowledge, checkpoint inhibitor-induced segmental vitiligo has yet to be documented.

Harlequin Color Change in a Neonate Positive to COVID-19: Case Report

Background: Harlequin color change is a benign, idiopathic, self-limiting disorder characterized by an appearance of skin divided into two distinctly colored areas. Its etiology is unknown but thought to be caused by immaturity of hypothalamic regulation of peripheral vascular tone. COVID-19 infection in neonates is infrequent and rarely symptomatic, with only a few cases described in the literature. In isolation, both conditions have low incidence. This is the first case reported in the world literature of harlequin color change in a newborn who tested positive for COVID-19. There isn’t a single publication that links harlequin color change to COVID-19, yet. The Case: Newborn of a 34-year old mother. Who at 3 hours of life presented progressive respiratory distress with whimpering and cyanosis. At 20 hours presented a sudden color change in the right hemibody with unilateral hyperemia and contralateral pallor, simultaneous with a demarcated line separating the left and right sides of the body, involving the trunk, extremities and face, this remained for 10 minutes and then began to fade on its own until it disappeared completely. There were no changes in vital parameters associated with this phenomenon. Only one episode was reported. The transient character and the strict unilateral distribution of the manifestations did not confirm any etiology other than Harlequin phenomenon. Subsequently the patient evolved to respiratory deterioration, multiorgan failure (SOFA: 21), died at 22 days of life due to respiratory arrest.&#x0D; Conclusion: This is the first ever documented case in worldwide literature of harlequin color change in a neonate positive to COVID-19. Given the low incidence of both entities in isolation and the fact that they were discovered in the same patient, we suggest a strong possibility of SARS-CoV-2 to be the source of the harlequin phenomena in this case and should be considered as an indicator of severe COVID in newborns, but further studies that expand the selection of patients with this condition are needed. There is no literature linking the harlequin phenomenon with COVID-19.

Dissipation-induced recurrence of non-Hermitian edge burst

In quantum mechanics, the Hermitian Hamiltonian is generally used to describe the ideal closed quantum system, but in reality, the physical system is closely related to the environment, and the open quantum system coupled to the environment can be described by the equivalent non-Hermitian Hamiltonian to a certain extent. Among them, the dissipation intensity is closely related to the dynamic properties of non-Hermitian quantum systems. Therefore, it is of great practical significance to study how dissipation affects particle loss. In this paper, the dynamic law related to dissipation intensity in a one-dimensional non-Hermitian system under open boundary condition is studied, and it is found that dissipation can induce the recurrence of edge burst. After the time-dependent evolution of the particles in the one-dimensional non-Hermitian dissipative lattice system with open boundary condition, there is an edge burst in the system, that is, there is a large probability of particle loss at the edge, and the edge burst disappears after increasing the intracell hopping. It is found that if the dissipation intensity increases or decreases, the edge burst will reappear. This kind of reappearance is different from the original edge burst, which is mainly manifested in the loss probability distribution of particles from the edge distribution to the bulk distribution, which is due to the difference in probability of particle motion direction between the two cases. Under the re-induced edge burst, the particles move leftward and rightward from their initial positions, and rebound from the left after having reached the boundary, forming a more obvious loss probability at the edge and gradually decreasing to the body area. In the original edge burst, the particles only move to the left with a greater probability, and are ‘trapped’ at the edge to completely dissipated, forming a distribution with an independent loss peak at the edge. The movement to the left is due to the non-Hermitian skin effect. The deeper reason for different movement directions is related to parity-time symmetry. Under the parameter near the parity-time symmetry breaking point, the loss probability of the particle is of unilateral distribution, and the loss probability of the particle moving to both sides is of bilateral distribution when it is far away. This is the description of the dissipation-induced edge burst recurrence phenomenon and its characteristics. In addition, this paper also studies the influence of impurity barrier on the probability distribution of particle loss in non-Hermitian dynamics. The results show that placing a small barrier on the non-dissipative &lt;i&gt;A&lt;/i&gt;-site can obviously hinder the particle motion, and when the barrier increases to a certain height, its influence on the particle motion tends to be unchanged. And the barrier at the dissipative &lt;i&gt;B&lt;/i&gt; lattice has little effect on the dynamics.

MRI changes and expressions of neuron-specific enolase and monocyte chemoattractant protein-1 in cerebrospinal fluid in patients with severe herpes simplex virus encephalitis.

The objective of this research was to analyze the MRI changes and the expression of neuron-specific enolase (NSE) and monocyte chemoattractant protein-1 (MCP-1) in cerebrospinal fluid (CSF) of patients with severe herpes simplex encephalitis. For this purpose, 68 patients with severe herpes simplex virus encephalitis diagnosed and treated in our hospital from April 2020 to April 2021 were selected as the study objects of the study group. In addition, 68 healthy people who underwent normal physical examinations in our hospital were selected as the control group at the same time. They were examined by magnetic resonance imaging (MRI) within one week after the study group was enrolled. CSF samples were collected one week after the onset of the disease in the study group and 2-4 days after the first spinal anesthesia in the control group, Enzyme linked immunosorbent assay (ELIEA) was used to detect the expression of NSE and MCP-1 in cerebrospinal fluid of the two groups, and the linear correlation between NSE and MCP-1 were analyzed. Results showed that compared with the control group, the expression of NSE and MCP-1 in the cerebrospinal fluid of the study group increased significantly (P<0.05). The expression of NSE and MCP-1 in patients with severe herpes simplex encephalitis in a coma was significantly higher than that in patients without severe herpes simplex encephalitis in a coma (P<0.05). NSE and MCP-1 were positively correlated (r=0.597, P=0.001). NSE and MCP-1 were risk factors for severe herpes simplex encephalitis, and the difference was statistically significant (P<0.05). In conclusion, magnetic resonance imaging of patients with severe herpes simplex encephalitis is characterized by multiple lesions in the temporal lobe, insula, and frontal lobe base (especially the marginal system involved) with unilateral or bilateral asymmetric distribution, and abnormal high expression of NSE and MCP-1 in the cerebrospinal fluid of such patients, which has important value in the early diagnosis of this disease.

Evaluation of Haller's Cells Prevalence in a Sample of Polish Population Assessed Using Panoramic Radiographs

Introduction: Haller's cells are air structures with variable presence in individuals. They are situated in the anterior part of the ethmoid bone on the inferior and medial walls of the orbits. Their presence can be symptomatic and they may also be an impediment in surgical procedures. A panoramic radiograph commonly used in dental diagnostics allows visualization of their presence. The aim of the study is characteristics and estimation of Haller's cell prevalence in a sample of the Polish population based on panoramic radiographs. Materials and Methods: The study consisted of 467 panoramic radiographs including patients of both genders (303 females and 164 males), aged 17–23 years with a mean of 20.2 years. All radiographs have been evaluated for Haller's cells' presence, shape, number, and location with gender predilection. Results: Haller's cells were found in 72 cases, which comprised 15.4% of the studied group, with a slightly higher prevalence in females (17.82% in females and 10.97% in males). The most predominant shape was oval. Unilateral distribution of the cells outnumbered bilateral variants. One to three Haller's cells were found on one side, in the own material. Conclusions: Panoramic radiograph revealed a relatively low prevalence of Haller's cells in a sample of the Polish population. It is possible to assess the shape and determine the exact number of these cells. Based on the panoramic examination, we can state that they are located more often unilaterally with a slightly higher prevalence in females.