Reversible cerebral vasoconstriction syndrome (RCVS) is a rare phenomenon that can present in the postpartum period. We show the experience of a 35‐year‐old patient who presented with headache after ...an uncomplicated pregnancy and vaginal delivery. She was initially diagnosed with pre‐eclampsia, and subsequently with RCVS following discovery of multifocal vascular narrowing on magnetic resonance arteriography (MRA). Verapamil was initiated, and at 1 month there was improvement intracranially, but cervical vertebral arterial narrowing, likely dissection, was discovered. Verapamil was continued and aspirin was initiated. Follow‐up imaging 5 months postpartum demonstrated near‐complete resolution of previously noted abnormalities, which remained stable at reimaging at 10 months postpartum. In conclusion, the symptoms of RCVS can mimic or coexist with pre‐eclampsia. Early intracranial imaging such as MRA can permit timely diagnosis and facilitate appropriate management and follow‐up.
Synopsis
Reversible cerebral vasoconstriction syndrome can mimic or coexist with pre‐eclampsia, and application of early intracranial imaging may facilitate timely diagnosis and initiation of appropriate management.
Undesired photoelectronic dormancy through active species decay is adverse to photoactivity enhancement. An insufficient extrinsic driving force leads to ultrafast deep charge trapping and ...photoactive species depopulation in carbon nitride (g‐C3N4). Excitation of shallow trapping in g‐C3N4 with long‐lived excited states opens up the possibility of pursuing high‐efficiency photocatalysis. Herein, a near‐field‐assisted model is constructed consisting of an In2O3‐cube/g‐C3N4 heterojunction associated with ultrafast photodynamic coupling. This In2O3‐cube‐induced near‐field assistance system provides catalytic “hot areas”, efficiently enhances the lifetimes of excited states and shallow trapping in g‐C3N4 and this favors an increased active species density. Optical simulations combined with time‐resolved transient absorption spectroscopy shows there is a built‐in charge transfer and the active species lifetimes are longer in the In2O3‐cube/g‐C3N4 hybrid. Besides these properties, the estimated overpotential and interfacial kinetics of the In2O3‐cube/g‐C3N4 hybrid co‐promotes the liquid phase reaction and also helps in boosting the photocatalytic performance. The photocatalytic results exhibit a tremendous improvement (34‐fold) for visible‐light‐driven hydrogen production. Near‐field‐assisted long‐lived active species and the influences of trap states is a novel finding for enhancing (g‐C3N4)‐based photocatalytic performance.
A near‐field‐assisted model containing an In2O3‐cube/g‐C3N4 heterojunction that can assist with ultrafast photodynamic coupling is constructed. Near‐field assistance is found to enhance long‐lived shallow charge trapping in g‐C3N4 so as to favor generating an increased photoactive species population. A mechanism for the photophysical and photochemical routes is deduced from time‐resolved spectroscopy combined with results from optical simulations.
A fast, sensitive, and reliable ultra‐high performance liquid chromatography with tandem mass spectrometry method has been developed and validated for the simultaneous quantitation and ...pharmacokinetic study of five phthalides (senkyunolide A, ligustilide, butylidenephthalide, 3‐butylphthalide, and levistilide A) in rat plasma after oral administration of Huo Luo Xiao Ling Dan (HLXLD) or Angelica sinensis‐‐Ligusticum chuanxiong herb pair (DG‐CX) between normal and arthritis rats. After extraction from blood, the analytes and internal standard were subjected to ultra‐high performance liquid chromatography with a Shim‐pack XR‐ODS column (75 × 3.0 mm2, 2.2 μm particles) and mobile phase was composed of methanol and water (containing 0.05% formic acid) under gradient elution conditions, with an electrospray ionization source in the positive ionization and multiple reaction monitoring mode. The lower limits of quantification were 0.192–0.800 ng/mL for all the analytes. Satisfactory linearity, precision, accuracy, mean extraction recovery, and acceptable matrix effect have been achieved. The validated method was successfully applied to a comparative pharmacokinetic study of five bioactive components in rat plasma after oral administration of HLXLD or DG‐CX alone, respectively, between normal and arthritic rats. The results showed that there were unlike characters of pharmacokinetics among different groups.
Patient-specific phantomless calibration of computed tomography (CT) scans has the potential to simplify and expand the use of pre-existing clinical CT for quantitative bone densitometry and bone ...strength analysis for diagnostic and monitoring purposes. In this study, we quantified the inter-operator reanalysis precision errors for a novel implementation of patient-specific phantomless calibration, using air and either aortic blood or hip adipose tissue as internal calibrating reference materials, and sought to confirm the equivalence between phantomless and (traditional) phantom-based measurements. CT scans of the spine and hip for 25 women and 15 men (mean±SD age of 67±9years, range 41–86years), one scan per anatomic site per patient, were analyzed independently by two analysts using the VirtuOst software (O.N. Diagnostics, Berkeley, CA). The scans were acquired at 120kVp, with a slice thickness/increment of 3mm or less, on nine different CT scanner models across 24 different scanners. The main parameters assessed were areal bone mineral density (BMD) at the hip (total hip and femoral neck), trabecular volumetric BMD at the spine, and vertebral and femoral strength by finite element analysis; other volumetric BMD measures were also assessed. We found that the reanalysis precision errors for all phantomless measurements were ≤0.5%, which was as good as for phantom calibration. Regression analysis indicated equivalence of the phantom- versus phantomless-calibrated measurements (slope not different than unity, R2≥0.98). Of the main parameters assessed, non-significant paired mean differences (n=40) between the two measurements ranged from 0.6% for hip areal BMD to 1.1% for mid-vertebral trabecular BMD. These results indicate that phantom-equivalent measurements of both BMD and finite element-derived bone strength can be reliably obtained from CT scans using patient-specific phantomless calibration.
•Phantomless calibration of CT scans has excellent inter-operator precision.•Precision for finite element-derived bone strength is comparable to precision for BMD.•Accuracy of phantomless calibration was confirmed vs. phantom calibration.
Although infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has pleiotropic and systemic effects in some individuals
, many others experience milder symptoms. Here, to gain a ...more comprehensive understanding of the distinction between severe and mild phenotypes in the pathology of coronavirus disease 2019 (COVID-19) and its origins, we performed a whole-blood-preserving single-cell analysis protocol to integrate contributions from all major immune cell types of the blood-including neutrophils, monocytes, platelets, lymphocytes and the contents of the serum. Patients with mild COVID-19 exhibit a coordinated pattern of expression of interferon-stimulated genes (ISGs)
across every cell population, whereas these ISG-expressing cells are systemically absent in patients with severe disease. Paradoxically, individuals with severe COVID-19 produce very high titres of anti-SARS-CoV-2 antibodies and have a lower viral load compared to individuals with mild disease. Examination of the serum from patients with severe COVID-19 shows that these patients uniquely produce antibodies that functionally block the production of the ISG-expressing cells associated with mild disease, by activating conserved signalling circuits that dampen cellular responses to interferons. Overzealous antibody responses pit the immune system against itself in many patients with COVID-19, and perhaps also in individuals with other viral infections. Our findings reveal potential targets for immunotherapies in patients with severe COVID-19 to re-engage viral defence.
Objectives
To identify a quick clinical tool to assess the risk of delirium after elective surgery.
Design
Prospective observational study.
Setting
Preoperative assessment clinic at the Veterans ...Affairs Portland Health Care System.
Participants
Community‐living veterans aged 65 and older scheduled for elective surgery requiring general or major anesthesia.
Measurements
Confusion Assessment Method (CAM) or Family Confusion Assessment Method (FAM‐CAM). Data on education, medications, substance use, Patient Health Questionnaire (PHQ‐9), Study of Osteoporotic Fractures Frailty, Mini‐Cog, and Charlson‐Deyo score were collected preoperatively.
Results
Of 114 veterans who agreed to participate, 76 completed the final delirium assessment. Ten of the 76 (13%) developed delirium in the 72 hours after surgery as assessed using the CAM or FAM‐CAM. In bivariate analysis, factors that increased the odds of delirium at least three times were low education; poor PHQ‐9, clock draw, word recall, Mini‐Cog, and poor preoperative orientation scores; alcohol use; and higher comorbidities as measured using Charlson‐Deyo index. Scoring the Mini‐Cog from 0 to 5 had a higher predictive power (area under the receiving operating characteristic curve = 0.77) than other approaches to scoring the Mini‐Cog. Other models did not significantly improve prediction of postoperative delirium risk and would be complicated to use in a clinical setting.
Conclusion
In this sample of veterans who had elective surgery with major anesthesia, Mini‐Cog score predicted likelihood of postoperative delirium.
IMPORTANCE Muscle pain, fatigue, and weakness are common adverse effects of statin medications and may decrease physical activity in older men. OBJECTIVE To determine whether statin use is associated ...with physical activity, longitudinally and cross-sectionally. DESIGN, SETTING, AND PARTICIPANTS Men participating in the Osteoporotic Fractures in Men Study (N = 5994), a multicenter prospective cohort study of community-living men 65 years and older, enrolled between March 2000 and April 2002. Follow-up was conducted through 2009. EXPOSURES Statin use as determined by an inventory of medications (taken within the last 30 days). In cross-sectional analyses (n = 4137), statin use categories were users and nonusers. In longitudinal analyses (n = 3039), categories were prevalent users (baseline use and throughout the study), new users (initiated use during the study), and nonusers (never used). MAIN OUTCOMES AND MEASURES Self-reported physical activity at baseline and 2 follow-up visits using the Physical Activity Scale for the Elderly (PASE). At the third visit, an accelerometer measured metabolic equivalents (METs kilocalories per kilogram per hour) and minutes of moderate activity (METs ≥3.0), vigorous activity (METs ≥6.0), and sedentary behavior (METs ≤1.5). RESULTS At baseline, 989 men (24%) were users and 3148 (76%) were nonusers. The adjusted difference in baseline PASE between users and nonusers was −5.8 points (95% CI, −10.9 to −0.7 points). A total of 3039 men met the inclusion criteria for longitudinal analysis: 727 (24%) prevalent users, 845 (28%) new users, and 1467 (48%) nonusers. PASE score declined by a mean (95% CI) of 2.5 (2.0 to 3.0) points per year for nonusers and 2.8 (2.1 to 3.5) points per year for prevalent users, a nonstatistical difference (0.3 −0.5 to 1.0 points). For new users, annual PASE score declined at a faster rate than nonusers (difference of 0.9 95% CI, 0.1 to 1.7 points). A total of 3071 men had adequate accelerometry data, 1542 (50%) were statin users. Statin users expended less METs (0.03 95% CI, 0.02-0.04 METs less) and engaged in less moderate physical activity (5.4 95% CI, 1.9-8.8 fewer minutes per day), less vigorous activity (0.6 95% CI, 0.1-1.1 fewer minutes per day), and more sedentary behavior (7.6 95% CI, 2.6-12.4 greater minutes per day). CONCLUSIONS AND RELEVANCE Statin use was associated with modestly lower physical activity among community-living men, even after accounting for medical history and other potentially confounding factors. The clinical significance of these findings deserves further investigation.
Abstract Background Postoperative pulmonary complications (PPCs) after major abdominal surgery are common and associated with significant morbidity and high cost of care. The objective of this study ...was to identify the risk factors for PPCs after major abdominal surgery. Materials and methods The American College of Surgeons' National Surgical Quality Improvement Program database from 2005–2012 was queried for patients who underwent major abdominal surgery (esophagectomy, gastrectomy, pacnreatectomy, enterectomy, hepatectomy, colectomy, and proctectomy). Predictors of PPCs were identified using multivariate logistic regression. Results Of 165,196 patients who underwent major abdominal surgery 9595 (5.8%) suffered PPCs (pneumonia 3.2%, prolonged ventilator support ≥48 h 3.0%, and unplanned intubation 2.8%). On multivariate analysis, significant predictors of overall and individual PPCs include esophagectomy, advanced American Society of Anesthesiology Classification System, dependent functional status, prolonged operative time, age ≥80 y, severe chronic obstructive pulmonary disease, preoperative shock, ascites, and smoking. Obesity was not a risk factor. Female gender was overall protective for PPCs. Conclusions PPCs after abdominal procedures are associated with a number of clinical variables. Esophageal operations and American Society of Anesthesiology Classification System were the strongest predictors. These results provide a framework for identifying patients at risk for developing pulmonary complications after major abdominal surgery.
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