bluuebunny/crossref_metadata_2025 huggingface dataset:
Spatially Resolved Assessment and Analysis of Al-Zn, Mg, and Mg/Al-Zn Metal-Rich Primers Applied to AA 7075-T651 in Full Immersion
Authors: Korjenic A. , Romanovskaia E. , Scully J. R.
Published: August 2024

The scanning vibrating electrode technique (SVET) was utilized to monitor localized corrosion and substrate protection of three metal-rich primers (MRP). The ability to suppress localized corrosion and provide widespread cathodic polarization to enable sacrificial anode-based cathodic protection of a AA 7075-T651 substrate with either an aluminum-rich primer (AlRP), magnesium-rich primer (MgRP), or a composite magnesium + aluminum-rich primer (MgAlRP) in a polyamide-based epoxy primer coatings fully immersed in 1 mM NaCl was investigated. Pigments did not activate uniformly in each MRP. The notion of throwing power polarizing the bare substrate and uniform current and potential distributions at scratch sites does not describe the behavior observed. In cases where activation occurred, protection was noticed in the form of suppression of local anodes on bare AA 7075-T651. Local corrosion was suppressed on heterogeneously corroding AA 7075-T651 with strong local anodes and cathodes. Widespread cathodic polarization was absent. The MgRP and MgAlRP were shown to provide superior local corrosion suppression associated with pitting on AA 7075-T651 compared to the AlRP.
A toolbox of strategies to improve test-taking skills: a comparison of student perceptions
Authors: Metz Cynthia J. , Metz Michael J. , Falcone Jeff C.
Published: August 2024

Professional students in the health sciences may need to improve their test-taking skills for high-level and integrated assessments. A toolbox of strategies was implemented in a Dental Physiology course that included an introductory video, problem solution videos for practice problems, collaborative group assessments, and unit exam debriefings. The students reported that the strategies were helpful, improving their preparation and test-taking strategies for summative exams such as the Integrated National Board Dental Examination.
Students respond positively to an instructor collecting and sharing aggregated class demographic data from a survey in a high-enrollment physiology course
Authors: Edwards Baylee A. , Kolodisner Jude , Youngblood Jacob P. , Cooper Katelyn M. , Brownell Sara E.
Published: August 2024

This study examined undergraduate student perceptions of a high-enrollment physiology instructor collecting student demographics and sharing aggregated results to promote course inclusion. Most students perceived the collection and sharing positively, with women and nonbinary students, as well as liberal students, perceiving greater benefits from the data collection than their counterparts. Our results indicate that collecting and sharing in aggregate student demographics may be an effective way to enhance student-instructor relationships in high-enrollment science courses.
Chronic mistimed feeding results in renal fibrosis and disrupted circadian blood pressure rhythms
Authors: Benjamin Jazmine I. , Pati Paramita , Luong Tha , Liu Xiaofen , De Miguel Carmen , Pollock Jennifer S. , Pollock David M.
Published: August 2024

Circadian disruption through mistimed feeding resulted in nondipping blood pressure, renal fibrosis, and arterial stiffness that were less severe in females versus males. Mice fed exclusively during the daytime maintain their circadian rhythms of locomotor activity regardless of their loss of blood pressure rhythms. Although these mice ate less food, they maintained body weight, suggesting inefficiencies in overall metabolism. These findings demonstrate the importance of maintaining optimal food intake patterns to prevent cardiorenal pathophysiology.
Whole body sweat rate prediction: indoor treadmill and cycle ergometer exercise
Authors: Jay Ollie , Périard Julien D. , Hunt Lindsey , Ren Haiyu , Suh HyunGyu , Gonzalez Richard R. , Sawka Michael N.
Published: August 2024

This study presents the development of new proprietary whole body sweat rate prediction models for people exercising indoors on a cycle ergometer or treadmill using simple input parameters and delivered through a publicly available online calculator: https://sweatratecalculator.com . In an independent validation group, the predictive models for both indoor cycling and treadmill exercise were accurate across moderate to high exercise intensities in temperate to hot conditions. These equations will enable individualized hydration management during physical training and exercise physiology experiments.
Beyond the Scalpel: Advancing Strategic Approaches and Targeted Therapies in Nonexcisable Melanomas
Authors: Li Vivian , Frasier Kelly , Vinagolu-Baur Julia , Chapman Olivia , Loperfito Alexandra , Daly Kathleen , Taranto Viktoria
Published: August 2024

Melanoma in challenging anatomical locations such as the face, acral surfaces, and mucosal areas presents unique hurdles for surgical excision. This review examines alternative nonsurgical treatment modalities in the context of these complexities, addressing the gaps in current guidelines and the varied efficacy of existing therapies. A comprehensive literature search was conducted using PubMed, Embase, and Web of Science databases. The review focuses on peer‐reviewed articles discussing nonsurgical treatment options for melanoma in complex anatomical locations. Articles were screened by three independent researchers, ensuring a broad analysis of topical agents, immunotherapies, radiotherapies, and targeted therapies. The review highlights significant advancements in localized treatments such as imiquimod and intralesional therapy with talimogene laherparepvec (T‐VEC), which show promise in managing nonexcisable melanomas. BRAF and MEK inhibitors, as well as checkpoint inhibitors targeting CTLA‐4 and PD‐1/PD‐L1 pathways, demonstrate improved survival rates but pose challenges with resistance and systemic side effects. Radiotherapy serves as an adjunctive strategy due to melanoma’s inherent radioresistant properties. Despite advancements, there is a notable absence of comprehensive, evidence‐based protocols to guide the treatment of melanoma in these critical areas. This paper underscores the need for standardized treatment guidelines that account for the efficacy, side effects, and psychosocial impacts of therapies. Future research should focus on refining existing treatments and exploring innovative modalities to enhance patient outcomes in the management of nonexcisable melanomas. Comprehensive guidelines and long‐term efficacy studies are essential to optimize care and improve the quality of life for patients afflicted with melanoma in challenging anatomical locations.
Performance of Domesticated Tiger Shrimp Postlarvae (Penaeus monodon) and Mud Crab (Scylla paramamosain) in Extensive Rice‐Shrimp Ponds
Authors: Hoang Tung , Nguyen Binh Thai , Huynh Quang Viet
Published: August 2024

This study assessed the performance of domesticated tiger shrimp Penaeus monodon postlarvae and mud crab Scylla paramamosain co‐cultured in 90 extensive rice‐shrimp ponds in the Mekong River Delta of Vietnam from 2022 to Sep 2023. Limited supplementary feeding was applied for only 20% of the studied ponds. Results show that ponds stocked with domesticated postlarvae produced significantly larger shrimps at harvest and had better postlarvae usage efficiency (P < 0.05) compared with those stocked with older postlarvae produced by wild‐caught broodstock. Furthermore, a combination of stocking domesticated postlarvae and using organic fertilizer for pond preparation and during the crop was found to significantly improve productivity by 28% and final harvest size by 67% (P < 0.05). Larger shrimps fetched 54% higher farm‐gate prices, thus significantly increasing gross revenue for farmers. Co‐culture of mud crab in rice‐shrimp ponds at low densities (0.2–0.7 pcs/m2) was popular and profitable. Productivity was 116–187 kg/ha/crop with a profit margin up to 92.8%. Income from mud crab was very similar to that from shrimp. The results of this study suggest that domesticated postlarvae of P. monodon should be used for stocking extensive systems, preferably in combination of using organic fertilizer to enhance natural foods. Further improvement of income and profit can be achieved if more attention is paid on crablet quality and quality improvement.
Design and Control of an Upper Limb Bionic Exoskeleton Rehabilitation Device Based on Tensegrity Structure
Authors: Ni Peng , Sun Jianwei , Dong Jialin
Published: August 2024

Upper limb exoskeleton rehabilitation devices can improve the quality of rehabilitation and relieve the pressure of rehabilitation medical treatment, which is a research hotspot in the field of medical robots. Aiming at the problems such as large volume, high cost, low comfort, and difficulty in promotion of traditional exoskeleton rehabilitation devices, and considering the lightweight, discontinuous, high flexibility, and high biomimetic characteristics of tensegrity structure, we designed an upper limb bionic exoskeleton rehabilitation device based on tensegrity structure. First, this article uses mapping methods to establish a mapping model for upper limb exoskeletons based on the tensegrity structure and designs the overall structure of upper limb exoskeletons based on the mapping model. Second, a bionic elbow joint device based on gear and rack was designed, and the stability of the bionic elbow joint was proved using the positive definite matrix method. This device can simulate the micro displacement between bones of the human elbow joint, improve the axial matching ability between the upper limbs and the rehabilitation device, and enhance the comfort of rehabilitation. Third, an impedance control scheme based on back propagation (BP) neural network was designed to address the low control accuracy of flexible structures and patient spasms. Finally, we designed the impedance control scheme of the PSO–BP neural network based on a fuzzy rehabilitation state evaluator. The experimental results show that the exoskeleton rehabilitation device has good flexion motion stability and assist ability and has significant advantages in volume and mobility. The control strategy proposed in this paper has high control precision and adaptive ability and has potential application value in the field of medical rehabilitation.
Wildlife as a Sentinel for Pathogen Introduction in Nonendemic Areas: First Detection of Leishmania tropica in Wildlife in Spain
Authors: Azami-Conesa Iris , Matas Méndez Pablo , Pérez-Moreno Paula , Carrión Javier , Alunda José María , Mateo Barrientos Marta , Gómez-Muñoz María Teresa
Published: August 2024

Leishmaniasis is a chronic global arthropod‐borne zoonotic disease produced by several species of Leishmania with cutaneous, mucocutaneous, and visceral clinical manifestations. In Spain, only Leishmania infantum has been reported so far, although other species of Leishmania, such as L. tropica and L. major, are present in surrounding countries. The aim of this work is to analyze the occurrence of Leishmania spp. infection in European wildcats (Felis silvestris) as sentinels, including their genotypic characterization. Necropsies of 18 road‐killed wildcats were conducted. Samples of ear skin and spleen were taken for DNA isolation and PCR of the highly sensitive SSU-rDNA target. Subsequent PCR tests were performed using more specific targets for the determination of Leishmania species: hsp70 and ITS1. Positive samples were sequenced, and phylogenetic trees were constructed. Seven wildcats were found positive for Leishmania spp. Based on the hsp70 and ITS1 sequences, an animal was found to be infected only with L. tropica in ear skin samples, while two cats were found to be infected with L. infantum in both the ear skin and the spleen. In one animal, a clear sequence of L. infantum ITS1 and a sequence of L. tropica hsp70 were obtained from the ear skin. Since hsp70 and ITS1 sequencing was not possible in three cats, the species of Leishmania infecting them was not determined. This is the first report of autochthonous infection with L. tropica in the Iberian Peninsula. Health care professionals, including physicians, dermatologists, and veterinarians, must be aware of this for a correct diagnosis, treatment, and management of possible coinfections.
Green Synthesis of Citrus sinensis Peel Extract‐Mediated Ag‐TiO2 and Its Application as a Photocatalyst for Organic Molecules and Antimicrobial Agent
Authors: Narh Daniel , Sampson Benjamin , Ocrah Junior Samuel , Pokuaa Manu Gloria , Agyei-Tuffour Benjamin , Nyankson Emmanuel , Kwame Efavi Johnson
Published: August 2024

The growing focus on green chemistry and its application in nanomaterials has sparked a desire to explore more efficient and environmentally friendly synthesis methods. In this work, Citrus sinensis peel extract was used to synthesize silver‐titanium dioxide, and the photocatalytic properties were evaluated in comparison with pristine titanium dioxide for wastewater purification and the antimicrobial efficacy tested. Titanium dioxide was coated with silver nanoparticles using weighted amounts of silver nitrate, with C. sinensis peel extract serving as the reducing agent. Characterization via X‐ray diffraction, Fourier‐transform infrared spectroscopy, scanning electron microscopy‐energy dispersive spectroscopy, and ultraviolet‐visible spectrophotometry confirmed silver‐titanium dioxide formation. The maximum photodegradation rate was observed with a 1.5 wt.% silver‐titanium dioxide composite using rhodamine B, proving it to be the most effective for organic molecule photodegradation. Subsequently, silver nanoparticles and silver‐titanium dioxide demonstrated growth inhibition against strains of Staphylococcus aureus and Escherichia coli, highlighting their potential for wastewater treatment and microbial control.
Bioaccessibility and Speciation of Iron from Aqueous Extracts of Moringa oleifera Leaves
Authors: Mawouma Saliou , Hamidou Yaya Souaibou , Mbyeya Jude , Doudou Walko Florence , Awoudamkine Emmanuel , Mbofung Funtong Carl Moses
Published: August 2024

Investigating the different chemical species of soluble iron in food digests provides more relevant information on the nutritional potential of an iron‐rich food. The objective of this study was to assess the bioaccessibility and speciation of iron from various aqueous extracts of Moringa (Moringa oleifera) leaves. Aqueous extracts were prepared from fresh and dried Moringa leaves using infusion and decoction methods. Spectrophotometric assays were performed to quantify inhibitors and enhancers of iron absorption in the extracts, bioaccessible iron, and its different chemical species. The highest contents of inhibitors (239.43 mg/L for polyphenols and 2.92 mg/L for phytates) and enhancers of iron absorption (1.58 mmol/L for carotenoids and 488.00 mg/L for ascorbic acid) were found in the 5‐minute decoction extract of fresh leaves, and the lowest in all infusion extracts (27.34 mg/L for polyphenols, 0.50 mg/L for phytates, 0.15 mmol/L for carotenoids, and 86.00 mg/L for ascorbic acid). The percentages of bioaccessible iron were higher for decoction extracts (42.57–52.70%) compared to infusion extracts (33.89–36.44%). Ferrous iron was the dominant inorganic species of bioaccessible iron and was more concentrated in the digests of decoction extracts (1.32–4.85 mg/L). The highest content of organic iron (5.33 mg/L) was found in the digest of the 8‐minute decoction extract of dried leaves. Drinking decoction extracts of fresh and dried Moringa leaves could be recommended to alleviate iron deficiency in vulnerable groups of the population living in areas where this plant can grow.
A Case of Metastatic Vulvar Choriocarcinoma Misdiagnosed as Vulvar Abscess: A Case Report
Authors: Mrema Alita , Kiwia Prudence H. , Shaban Shaban J. , Mohamed Anwar Z. , Abdallah Latifa Rajab , Kiaratu Rajabu , Mahoyogo John , Chuwa Agapiti , Mvunta David H.
Published: August 2024

Background: Metastatic vulvar choriocarcinoma, a rare ectopic gestational trophoblastic neoplasia (GTN), often presents a diagnostic challenge due to its mimicry of other conditions, particularly in resource‐limited settings. Its primary symptom is abnormal vaginal bleeding without a clear cause. Consequently, diagnosing and managing it poses difficulties for many low‐resource health facilities, as evidenced by the current case.

Case Presentation: We present the case of a 25‐year‐old, P2+2+2L2, who had a large painless, bleeding vulva mass for nearly 5 months. This followed a spontaneous abortion the month prior. The mass gradually increased in size and was accompanied by fever, pus discharge, and weight loss. Despite being treated at multiple health facilities for a vulvar abscess, there was no improvement. A diagnosis was finally made at a tertiary facility where elevated quantitative serum beta‐human chorionic gonadotropin (hCG) (β‐hCG) was noted. Due to uncontrollable vulva bleeding, she was referred to another tertiary facility for emergency radiotherapy. Following stabilization, chemotherapy was administered using the EMA‐CO protocol.

Conclusion: The report highlights the difficulty in diagnosing vulvar choriocarcinoma, underscoring the importance of a high index of suspicion. Clinical tests such as serum (β‐hCG) and imaging studies are crucial for diagnosis. In resource‐limited settings, a simple strip‐based urine pregnancy test with serial dilutions can be sufficient for diagnosing and managing vulvar choriocarcinoma.
Galectin-9 Mediates the Functions of Microglia in the Hypoxic Brain Tumor Microenvironment
Authors: Lee Chanju , Yu Dahee , Kim Hyung-Seok , Kim Ki Sun , Chang Chi Young , Yoon Hee Jung , Won Su Bin , Kim Dae Yeon , Goh Eun Ah , Lee Yong Sun , Park Jong-Bae , Kim Sang Soo , Park Eun Jung
Published: August 2024

Galectin-9 (Gal-9) is a multifaceted regulator of various pathophysiologic processes that exerts positive or negative effects in a context-dependent manner. In this study, we elucidated the distinctive functional properties of Gal-9 on myeloid cells within the brain tumor microenvironment (TME). Gal-9–expressing cells were abundant at the hypoxic tumor edge in the tumor-bearing ipsilateral hemisphere compared with the contralateral hemisphere in an intracranial mouse brain tumor model. Gal-9 was highly expressed in microglia and macrophages in tumor-infiltrating cells. In primary glia, both the expression and secretion of Gal-9 were influenced by tumors. Analysis of a human glioblastoma bulk RNA sequencing dataset and a single-cell RNA sequencing dataset from a murine glioma model revealed a correlation between Gal-9 expression and glial cell activation. Notably, the Gal-9high microglial subset was functionally distinct from the Gal-9neg/low subset in the brain TME. Gal-9high microglia exhibited properties of inflammatory activation and higher rates of cell death, whereas Gal-9neg/low microglia displayed a superior phagocytic ability against brain tumor cells. Blockade of Gal-9 suppressed tumor growth and altered the activity of glial and T cells in a mouse glioma model. Additionally, glial Gal-9 expression was regulated by hypoxia-inducible factor-2α in the hypoxic brain TME. Myeloid-specific hypoxia-inducible factor-2α deficiency led to attenuated tumor progression. Together, these findings reveal that Gal-9 on myeloid cells is an immunoregulator and putative therapeutic target in brain tumors.

Significance: Galectin-9 serves as an immune checkpoint molecule that modulates the functional properties of microglia in the brain tumor microenvironment and could potentially be targeted to effectively treat brain tumors.
Supplementary Figure S3 from The Effect of Exposure to Neighborhood Violence on Glucocorticoid Receptor Signaling in Lung Tumors
Authors: Heath Hannah , Yoo Jin Y. , Akter Sabrina , Jain Atharva , Sharma Vani , McGee Hannah , Soliman Aiman , Mahmoud Abeer M. , Matthews Alicia K. , Winn Robert A. , Madak-Erdogan Zeynep , Kim Sage J.
Published: August 2024

Magnitude of GR binding enrichment in tumor and normal tissue samples from patients in low compared to high-violence neighborhoods.
Insulin Pump Therapy in Type 1 Diabetic Patients: Experience at the American University of Beirut Medical Center
Authors: Merheb M. , Chaiban J. , Salti I. , Sammak R. , Choucair M. , Nasrallah M.
Published: August 2024

Obesity during pregnancy has been shown to carry significant risk to both mother and child. The role of uncontrolled weight gain during pregnancy has not been fully elucidated. The study analysed the incidence of gestational hypertension and fetal macrosomia in various groups of mothers according to their BMI and antenatal weight gain. A definite statistically significant increased risk of both gestational hypertension and infant macrosomia was demonstrated with increasing BMI. This was compounded by increases in antenatal birth weight in all ranges of maternal BMI suggesting that adverse maternal metabolic parameters may contribute towards promoting the development of maternal and fetal complications. A restricted calorific intake in obese individuals during pregnancy may contribute towards decreasing the relative risks to both mother and child.
Gender: does it have a role in bleeding time in Caucasians with well controlled type 2 diabetes?
Authors: Barre D.E. , Mizier-Barre K.A. , Griscti O. , Hafez K.
Published: August 2024

Background: Bleeding times are decreased in type 2 diabetics presenting an enhanced risk of myocardial infarction and subsequent death. It is controversial whether males have a greater risk of myocardial infarction and resultant death in type 2 diabetes. Objective: The purpose of this study was to review the literature regarding gender in bleeding time and to test the hypothesis that there would be gender inequality in bleeding time in well-controlled Caucasian Type 2 diabetics in Cape Breton, Nova Scotia. This study revealed significantly shorter bleeding times in males. Thus it may be that males should be more aggressively treated to increase bleeding time and hence to more equitably manage the risk of myocardial infarction and subsequent death. Ultimately it will have to be determined what bleeding time thresholds are suitable for intervention and indeed what the most appropriate intervention is at each threshold and what role gender may play in these features in type 2 diabetics. However, this was only a very small study and a much larger one would answer whether there is gender inequality in bleeding time among persons with well-controlled type 2 diabetes.
Screening for Diabetes is possible and should be based on Autoantibody and Genetic Profiles
Authors: Grant Paul
Published: August 2024

Diabetes is a growing health problem with large health and economic implications. New technological advances give rise to the potential for effective national screening programmes. It has been known for some time that type 1 diabetes can be successfully predicted with a profile of autoantibodies. Recent developments in immunomodulatory therapies offer a suitable weapon. Type 2 diabetes is a common disease that is multifactorial but has several recently identified genetic polymorphisms that when combined contribute to a substantial risk of developing the condition. Lifestyle intervention in those with prediabetes is known to limit disease development and progression. This paper explores the above subjects and hypothesises that these developments suitably honed would be able to fulfil the criteria for an effective national screening programme.
Unveiling Neglected Concerns: Possible Severe Hepatic Complications after Nephrectomy in Autosomal Dominant Polycystic Kidney Disease – A Case Report
Authors: De Rosa Liliana Italia , Catania Martina , Tunesi Francesca , Vespa Marta , Bucci Romina , Kola Kristiana , Vezzoli Giuseppe , Sciarrone Alibrandi Maria Teresa
Published: August 2024

Introduction: Autosomal dominant polycystic kidney disease (ADPKD) is the most common genetic kidney disease and the 4th leading cause of renal replacement therapy in the world. ADPKD is a systemic disorder as cysts may develop in several organs. Liver cysts are the most common extrarenal manifestations and are often incidentally detected. Even though cysts do not influence liver function, they can grow to a very great size and can significantly enlarge liver volume, causing structural distortion of the biliary tree and patient discomfort due to the mass effect. Nephrectomy is frequently considered in preparation for renal transplantation in patients with remarkable kidneys’ enlargement. There are currently no globally recognized clinical guidelines for nephrectomy. Although cysts do not normally affect liver function in ADPKD, after nephrectomy cases of liver fibrosis and Budd-Chiari have been reported. These are uncommon disorders due to the obstruction of the blood flow in the hepatic venous causing spleen and liver volume enlargement, portal hypertension, and hepatic cirrhosis. Case Presentation: We present a case of hepatic fibrosis with splenomegaly and severe pancytopenia as a tardive complication after bilateral nephrectomy in 47-year-old ADPKD patient. Conclusion: This finding underscores the critical significance of meticulously examining the anatomical relationship between polycystic kidneys and the liver before performing nephrectomy. Additionally, it highlights the importance of assessing liver involvement and associated complications. By integrating liver assessment into the criteria, we can significantly enhance patient care and improve the overall management of ADPKD before kidney transplantation.
Recurrent Upper Gastrointestinal Bleeding due to Radiation-Induced Hemorrhagic Gastroduodenal Ectasia: A Review of Current Treatment Options for Radiation-Induced Gastric Injury
Authors: Jarrett Simone A. , Talati Rushi Kaushik , Hasbun Johann , Cao Wenqing , Smukalla Scott M.
Published: August 2024

Introduction: Acute upper gastrointestinal bleeding is one of the most common medical emergencies that present to the hospital, and delineating the underlying etiology is essential to provide adequate definitive treatment. The purpose of this case report was to review the diagnosis and treatment of a rare complication known as radiation-induced hemorrhagic gastritis (RIHG) that can occur in patients with prior radiation exposure. The motivation for this study arose from the identification of a case within our institution. Case Presentation: The study involved a review of the diagnosis and management of a patient who presented with anemia and recurrent episodes of gastrointestinal bleeding at our institution after undergoing treatment for metastatic biliary adenocarcinoma. With the advent of new therapies, we aimed to investigate the various techniques utilized to manage these patients and highlight the importance of maintaining a high index of suspicion for RIHG as a potential etiology of gastrointestinal bleeding in patients with a relevant medical history of radiation exposure. Despite the literature review, we found that there is a lack of guidelines in the approach to the management of these patients. Conclusion: This case report underscores the rarity of radiation-induced gastritis and the complications that may arise from its diagnosis, including recurrent GI bleeding. Further investigation into identifying definitive treatment and creating guidelines for its management is desperately needed.
The Management of Two Cases with Retinal Arterial Macroaneurysm by Anti-Vascular Endothelial Growth Factor
Authors: Takamiya Michiko
Published: August 2024

Introduction: We report on one case of age-related macular degeneration and one case of diabetic macular edema with concomitant retinal arterial macroaneurysm (RAM) that were treated with anti-vascular endothelial growth factor (VEGF) intravitreal injections. Case Presentation: Case 1 involved a 71-year-old woman with a 30-year history of diabetes who was undergoing dialysis. Pretreatment visual acuity in the right eye was 0.4. Fundus fluorescein angiography (FA) showed that numerous microaneurysms and RAM were located at a distance of two papillary diameters from the macular area. Diabetic macular edema was diagnosed. After 12 anti-VEGF injections, the macular edema resolved, microaneurysms decreased, and the RAM also disappeared. Visual acuity in the right eye improved to 0.7. Case 2 involved an 81-year-old woman receiving treatment for disorders including hypertension and dyslipidemia. Pretreatment visual acuity in the right eye was 0.03. And vitreous hemorrhage was present. After one ranibizumab intravitreal injection, the fundus became clearly visible. Macular subretinal hemorrhage and an RAM in the upper macula area were evident on FA and optical coherence tomography. After four intravitreal injections of ranibizumab, macular hemorrhage resolved, RAM disappeared, and visual acuity improved to 0.2. All cases were treated by intravitreal injection of anti-VEGF. After several injections, the macular hemorrhage or macular edema was resolved. RAM disappeared, and visual acuity improved. Conclusion: Intravitreal injection of anti-VEGF appears effective for age-related macular degeneration or diabetic macular edema with concomitant RAM. Although anti-VEGF intravitreal injections are not covered by health insurance for the treatment of RAM, their effectiveness means that the expansion of indications is desirable.
Submacular and Intraretinal Fluid Associated with Arteritic Anterior Ischemic Optic Neuropathy
Authors: Solish Danielle , Micieli Jonathan
Published: August 2024

Introduction: Anterior ischemic optic neuropathy (AION) is an ischemic disorder of the optic nerve and a common cause of acute, painless, permanent vision loss. It is divided into two types: arteritic AION (AAION) and non-arteritic anterior ischemic optic neuropathy (NAION). Although subretinal fluid associated with optic disc edema has been reported in cases of NAION, it is rarely described in AAION. Case Presentation: An 86-year-old female with a history of polymyalgia rheumatica presented with sudden vision loss in the left eye. Initial examination revealed left pallid optic disc edema with peripapillary hemorrhages. Optical coherence tomography (OCT) of the left macula showed intraretinal and submacular fluid. The patient was started on 50 mg of oral prednisone daily. The diagnosis of giant cell arteritis (GCA) was later confirmed with a positive temporal artery biopsy. Three weeks after presentation, an OCT was completed which demonstrated complete resolution of the intraretinal and submacular fluid. Although the presence of both intraretinal and subretinal fluid has been previously documented in cases of NAION, it is rarely reported in a patient with GCA. Conclusion: This is a newly described case of subretinal and intraretinal fluid in a patient with AAION. We postulate that the pathophysiology behind this is mediated by associated choroidal ischemia leading to altered permeability. OCT is an important imaging modality allowing for signs of GCA to be better characterized.
CIC-DUX4 Rearranged Sarcoma Presenting in the Skin: Case Report
Authors: Amagai Ryo , Fujimura Taku , Hashimoto Akira , Yoshida Shinichirou , Asano Yoshihide
Published: August 2024

Introduction: Capicua transcriptional repressor (CIC)-DUX4 rearranged sarcoma is a subtype of CIC-rearranged sarcomas composed of undifferentiated Wilms’ tumor 1 (WT1)+, CD99+ round cells with recurrent CIC gene rearrangement. The diagnosis of CIC-rearranged sarcoma remains challenging, and the prognosis of CIC-rearranged sarcomas is poor. Case Presentation: In this report, we described a case of CIC-DUX4 rearranged sarcoma presenting in the skin, expressing WT1 and CD99 in a dot-like pattern. In addition, the assessment of genomic alterations using genome panel testing was useful to confirm the accurate diagnosis. Conclusion: Our present case suggests that widespread use of genomic panel testing in the future may lead to early treatment and improve the prognosis of CIC-rearranged sarcomas.
Bevacizumab and External Beam Radiation Therapy for Diffuse Choroidal Hemangioma in Sturge-Weber Syndrome: A Case Report
Authors: Yu Jeffrey , Ballouz Dena , Paulus Yannis M.
Published: August 2024

Introduction: Sturge-Weber syndrome, a congenital vascular disorder, is associated with diffuse choroidal hemangiomas in which the current mainstay of treatment is radiation therapy, including external beam radiation therapy (EBRT). The purpose of this case report was to present a novel combination of treatments for diffuse choroidal hemangioma. Case Presentation: A 37-year-old man with a history of Sturge-Weber-associated glaucoma presented with an acute-onset decrease in vision in the right eye. Best-corrected visual acuity (BCVA) at the presentation was 20/400 in the right eye. Examination revealed a total macula-off, bullous, folded exudative retinal detachment and findings consistent with diffuse choroidal hemangioma. The patient was treated with a single injection of intravitreal anti-vascular endothelial growth factor (anti-VEGF) agent bevacizumab and 10 fractions of EBRT of the right eye. Follow-up examination at 17 months demonstrated complete resolution of subretinal fluid and no evidence of choroidal elevation on B-scan. Final BCVA in the right eye was 20/1,000. Conclusion: This case uses simultaneous treatment with EBRT and bevacizumab in the treatment of diffuse choroidal hemangioma and associated exudative retinal detachment. Clinicians may use anti-VEGF agents early in the course of the disease in determining whether they may assist in preventing visual decline.
Multisystem Langerhans Cell Histiocytosis following Treatment of Initially Presumed Atopic Dermatitis with Dupilumab: A Case Report of an Extremely Confusing Scenario
Authors: Cheng Wenhao , Ren Hong , Hu Wenlong
Published: August 2024

Introduction: Atopic dermatitis (AD) is a common chronic, recurrent, and non-infectious inflammatory skin disease. Dupilumab is a human monoclonal antibody with clinical efficacy in severe AD and has a good safety profile. Case Presentation: We hereby describe a previously unreported case of multisystem Langerhans cell histiocytosis (MS-LCH) that is associated with a history of AD treatment using dupilumab. Conclusion: A single case of MS-LCH with a history of dupilumab treatment for AD was described for the first time. This case highlights that given its susceptibility to skin involvement, LCH needs to be considered as a differential diagnosis for skin lesions that are not improved by established therapies.
Lipoteichoic Acids Are Essential for Pneumococcal Colonization and Membrane Integrity
Authors: Brendel Max , Kohler Thomas P. , Neufend Janine V. , Puppe Astrid , Gisch Nicolas , Hammerschmidt Sven
Published: August 2024

Introduction: The hydrophilic, polymeric chain of the lipoteichoic acid (LTA) of the Gram-positive pathobiont Streptococcus pneumoniae is covalently linked to the glycosylglycerolipid α-d-glucopyranosyl-(1,3)-diacylglycerol by the LTA ligase TacL, leading to its fixation in the cytoplasmic membrane. Pneumococcal LTA, sharing identical repeating units with the wall teichoic acids (WTA), is dispensable for normal growth but required for full virulence in invasive infections. Methods: Mutants deficient in TacL and complemented strains constructed were tested for their growth, resistance against oxidative stress, and susceptibility against antimicrobial peptides. Further, the membrane fluidity of pneumococci, their capability to adhere to lung epithelial cells, and virulence in a Galleria mellonella as well as intranasal mouse infection model were assessed. Results: In the present study, we indicate that LTA is already indispensable for pneumococcal adherence to human nasopharyngeal cells and colonization in an intranasal mouse infection model. Mutants deficient for TacL did not show morphological defects. However, our analysis of pneumococcal membranes in different serotypes showed an altered membrane fluidity and surface protein abundance of lipoproteins in mutants deficient for LTA but not WTA. These mutants had a decreased membrane fluidity, exhibited higher amounts of lipoproteins, and showed an increased susceptibility to antimicrobial peptides. In complemented mutant strains, this defect was fully restored. Conclusion: Taken together, LTA is crucial for colonization and required to effectively protect pneumococci from innate immune defence mechanisms by maintaining the membrane integrity.
Novel Fundoscopic Features in Mucopolysaccharidosis Type VI: Multimodal Evaluation of Scleral Deposits
Authors: Magalhães Augusto , Ribeiro Margarida , Meira Jorge , Moleiro Ana Filipa , Rodrigues Esmeralda , Leão-Teles Elisa
Published: August 2024

Introduction: Mucopolysaccharidosis type VI (MPS VI) is a rare inherited metabolic disorder, primarily attributed to the deficiency of the enzyme N-acetylgalactosamine-4-sulfatase, responsible for the degradation of dermatan sulfate and chondroitin-4-sulfate. Therefore, there is a widespread accumulation of partially degraded glycosaminoglycans. Corneal opacification is the hallmark ocular feature in the MPS. Retinal and scleral involvement in this MPS is extremely rare. The purpose of this work was to describe novel fundoscopic alterations present in patients with MPS VI. Case Presentation: This is a case series involving three non-related patients referred to our department from the Unit of Inherited Metabolic Diseases. Multimodal imaging was performed in every patient. Fundus photography and enhanced depth imaging optical coherence tomography (EDI-OCT) were performed. Multiple areas of yellow/orange patches were observed on fundus photography, corresponding to areas in which deposits of intermediate reflectivity in the EDI-OCT could be seen at the scleral level with associated choroidal thinning. This finding suggested the presence of scleral deposits of glycosaminoglycans. Conclusion: To our knowledge, this is the first case series in the literature encompassing patients with MPS VI with suspected deposits of glycosaminoglycans in the sclera. The better control of the systemic comorbidities, the increase in life expectancy, and the timely management of corneal disease have allowed the identification of new, late-onset ocular manifestations in MPS patients. In addition, new imaging techniques have introduced the possibility of better characterizing and understanding these manifestations.
Nephroblastoma in Older Adult: Case Report and Review of Literature
Authors: Fernández-Ferreira Ricardo , Torres-Zazueta Jose Manuel , Martínez-Medrano César , Meléndez-Mendoza Adrián , Tavares-García Sonia , Muñoz Rubiano María Alejandra , Portela-Rubio Gredel , Robles-Castro Julieta , Robles-Aviña Jorge Alberto , Ruiz Morales Jose Manuel
Published: August 2024

Introduction: Nephroblastoma, or Wilms’ tumor, is a malignant renal neoplasm commonly found in children, is extremely rare in adults representing only 0.5% of all renal neoplasms. Adult Wilms tumor is rare, to our knowledge fewer than 300 cases have been reported in the English literature to date. However, in older adults after 60 years of age, only less than 45 cases have been reported. For this reason, treatment guidelines in adults still are lacking. Prognosis in nephroblastoma for adult patients is found to be worse than in children. Case Presentation: We report the case of a 65-year-old female with lumbar fossa mass, flank pain and hematuria, and pathologic diagnosis of Wilms tumor. We performed nephrectomy. No adjuvant treatment was given. Our patient remains asymptomatic and without evidence of recurrence 12 months after the surgery. Conclusion: Nephroblastoma in the elderly presents different clinical behavior and prognosis compared to nephroblastoma in children.
Tuberculosis of the Stomach Mimicking Gastric Submucosal Tumor: Diagnosis by Endoscopic Ultrasound
Authors: Maulahela Hasan , Annisa Nagita Gianty , Syam Ari Fahrial , Stephanie Marini , Dwina Billianti Yayi
Published: August 2024

Introduction: Gastrointestinal tuberculosis (TB), specifically gastric TB, is a rare form of extrapulmonary TB. Diagnosis proves challenging with nonspecific signs and symptoms. In this case report, a 22-year-old male came in with complaints of recurrent hematemesis and melena. Case Presentation: We found a submucosal mass with ulceration in the stomach cardia on esophagoduodenoscopy (EGD). The endoscopic ultrasound (EUS) finding was a hypoechoic submucosal lesion with a clear margin; specimens were taken using fine needle aspiration (FNA) for further histopathological examination. The result indicated granuloma of Mycobacterium Tuberculosis in pathology, suggesting that the diagnosis was gastric TB. The patient was then treated with antitubercular therapy regimen for 9 months. The previously documented mass in the stomach cardia was no longer visible on the follow-up endoscopy examination, and the patient was considered cured. Conclusion: This case shows that gastric tuberculosis should be considered in patients with gastrointestinal symptoms, especially those living in TB endemic regions. Endoscopic examinations, such as EGD and EUS, may aid in the diagnosis of gastric tuberculosis.
Caregiver Experience Survey of Anti-Vascular Endothelial Growth Factor Treatment for Diabetic Macular Edema and Neovascular Age-Related Macular Degeneration
Authors: Viola Francesco , Chi Gloria C. , Holekamp Nancy M. , Giocanti-Aurégan Audrey , García-Layana Alfredo , Peto Tunde , Kertes Peter J. , Mirt Mirela , Kotecha Aachal , Lambert Jérémy , Lewis Hannah B. , Gentile Brittany
Published: August 2024

Introduction: Diabetic macular edema (DME) and neovascular age-related macular degeneration (nAMD) require frequent anti-vascular endothelial growth factor (VEGF) treatment and monitoring visits. We aimed to understand the burden of treatment on caregivers. Methods: This multinational, noninterventional study used a cross-sectional survey of adult patients with DME or nAMD treated with anti-VEGF injections in the USA, Canada, France, Italy, Spain, and the UK. The survey assessed caregivers’ sociodemographic characteristics, patient relationships, patients’ clinical history and treatment experiences, caregivers’ experiences, and the Caregiver Reaction Assessment of caregiving burden. Results: Caregivers for patients with DME (n = 30) and nAMD (n = 95) completed surveys. Mean ± standard deviation (SD) age was 64.0 ± 13.4 years, and most were female (71.2%), white (70.4%), married (66.4%), and from Europe (67.2%). Most were caring for their mother/father or partner/spouse (85.6%). Mean ± SD length of time as a caregiver was 9.1 ± 10.0 years. Caregivers estimated they provided support for 4.2 ± 2.9 days/week and 6.0 ± 7.1 h/day on average. Nearly half of caregivers (45.6%) reported some impairment in daily activities, and more than two-thirds (70.5%) of working caregivers (n = 44) reported work absenteeism due to anti-VEGF treatment/monitoring appointments. At least one treatment barrier was reported by 66.7% and 50.5% of caregivers of patients with DME and nAMD, respectively, which were related to coronavirus disease 2019- (38.4%), clinic- (18.4%), social-/health- (13.6%), treatment- (10.4%), or financial-related factors (4.8%). Caregiver Reaction Assessment scores indicated mild-to-moderate burden, with higher caregiver schedule disruption scores associated with an increasing number of anti-VEGF treatment/monitoring visits among DME caregivers (r = 0.61). Conclusion: Caregivers devote substantial time to caregiving, leading to schedule disruptions and absenteeism for some working caregivers. Positive and negative impacts on caregiver mental health were reported.
Patterns of Telehealth Visits After the COVID‐19 Pandemic Among Individuals With or at Risk for Cardiovascular Disease in the United States
Authors: Bhatla Anjali , Ding Jie , Mhaimeed Omar , Spaulding Erin M. , Commodore‐Mensah Yvonne , Plante Timothy B. , Shan Rongzi , Marvel Francoise A. , Martin Seth S.
Published: August 2024

Background

Prior studies have shown that cardiovascular disease (CVD) can be effectively managed through telehealth. However, there are little national data on the use of telehealth in people with CVD or CVD risk factors. We aimed to determine the prevalence of telehealth visits and visit modality (video versus audio‐only) in people with CVD and CVD risk factors. We also assessed their rationale and satisfaction with telehealth visits.

Methods and Results

A nationally representative sample of 6252 participants from the 2022 Health Information National Trends Survey 6 was used. We defined the CVD risk categories as having no self‐reported CVD (coronary heart disease or heart failure) or CVD risk factors (hypertension, diabetes, obesity, or current smoking), CVD risk factors alone, and CVD. Multivariable logistic regression, adjusting for major sociodemographic factors, assessed the relationship between CVD risk and telehealth uptake. The weighted prevalence of using telehealth was 50% (95% CI, 44%–56%) for individuals with CVD and 40% (95% CI, 37%–43%) for those with CVD risk factors alone. Individuals with CVD had the highest odds of using any telehealth (audio‐only or video) (adjusted odds ratio [OR], 2.02 [95% CI, 1.39–2.93]) when compared with those without CVD or CVD risk factors. Notably, 21% (95% CI, 16.3%–25.6%) of patients with CVD used audio‐only visits (adjusted OR, 2.38 [95% CI, 1.55–3.64]) compared with patients without CVD or CVD risk factors.

Conclusions

In a nationally representative survey, there was high prevalence of any (video or audio‐only) telehealth visits in people with CVD, and audio‐only visits comprised a significant proportion of telehealth visits in this population.
Contrasting topologies of synchronous and asynchronous functional brain networks
Authors: McIntyre Clayton C. , Bahrami Mohsen , Shappell Heather M. , Lyday Robert G. , Fish Jeremie , Bollt Erik M. , Laurienti Paul J.
Published: August 2024

We generated asynchronous functional networks (aFNs) using a novel method called optimal causation entropy and compared aFN topology with the correlation-based synchronous functional networks (sFNs), which are commonly used in network neuroscience studies. Functional magnetic resonance imaging (fMRI) time series from 212 participants of the National Consortium on Alcohol and Neurodevelopment in Adolescence study were used to generate aFNs and sFNs. As a demonstration of how aFNs and sFNs can be used in tandem, we used multivariate mixed effects models to determine whether age interacted with node efficiency to influence connection probabilities in the two networks. After adjusting for differences in network density, aFNs had higher global efficiency but lower local efficiency than the sFNs. In the aFNs, nodes with the highest outgoing global efficiency tended to be in the brainstem and orbitofrontal cortex. aFN nodes with the highest incoming global efficiency tended to be members of the default mode network in sFNs. Age interacted with node global efficiency in aFNs and node local efficiency in sFNs to influence connection probability. We conclude that the sFN and aFN both offer information about functional brain connectivity that the other type of network does not.