Vestibular schwannomas, also called acoustic neuromas, are benign tumors of the vestibulocochlear nerve. Patients with these tumours almost always present with signs of hearing loss, and many also ...experience tinnitus, vertigo, and equilibrium problems. Following diagnosis with contrast enhanced MRI, patients may choose to observe the tumour with subsequent scans or seek active treatment in the form of microsurgery, radiosurgery, or radiotherapy. Unfortunately, definitive guidelines for treating vestibular schwannomas are lacking, because of insufficient evidence comparing the outcomes of therapeutic modalities.We present a contemporary case report, describing the finding of a vestibular schwannoma in a patient who presented with dizziness and a "clicking" sensation in the ear, but no hearing deficit. Audible clicking is a symptom that, to our knowledge, has not been associated with vestibular schwannoma in the literature. We discuss the diagnosis and patient's decision-making process, which led to treatment with Gamma Knife radiosurgery. Treatment resulted in an excellent radiographic response and complete hearing preservation. This case highlights an atypical presentation of vestibular schwannoma, associated with audible "clicks" and normal hearing. We also provide a concise review of the available literature on modern vestibular schwannoma treatment, which may be useful in guiding treatment decisions.
Obesity may affect the clinical course of Kawasaki disease (KD) in children and multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19.
To compare the prevalence of obesity ...and associations with clinical outcomes in patients with KD or MIS-C.
In this cohort study, analysis of International Kawasaki Disease Registry (IKDR) data on contemporaneous patients was conducted between January 1, 2020, and July 31, 2022 (42 sites, 8 countries). Patients with MIS-C (defined by Centers for Disease Control and Prevention criteria) and patients with KD (defined by American Heart Association criteria) were included. Patients with KD who had evidence of a recent COVID-19 infection or missing or unknown COVID-19 status were excluded.
Patient demographic characteristics, clinical features, disease course, and outcome variables were collected from the IKDR data set. Using body mass index (BMI)/weight z score percentile equivalents, patient weight was categorized as normal weight (BMI <85th percentile), overweight (BMI ≥85th to <95th percentile), and obese (BMI ≥95th percentile). The association between adiposity category and clinical features and outcomes was determined separately for KD and MIS-C patient groups.
Of 1767 children, 338 with KD (median age, 2.5 IQR, 1.2-5.0 years; 60.4% male) and 1429 with MIS-C (median age, 8.7 IQR, 5.3-12.4 years; 61.4% male) were contemporaneously included in the study. For patients with MIS-C vs KD, the prevalence of overweight (17.1% vs 11.5%) and obesity (23.7% vs 11.5%) was significantly higher (P < .001), with significantly higher adiposity z scores, even after adjustment for age, sex, and race and ethnicity. For patients with KD, apart from intensive care unit admission rate, adiposity category was not associated with laboratory test features or outcomes. For patients with MIS-C, higher adiposity category was associated with worse laboratory test values and outcomes, including a greater likelihood of shock, intensive care unit admission and inotrope requirement, and increased inflammatory markers, creatinine levels, and alanine aminotransferase levels. Adiposity category was not associated with coronary artery abnormalities for either MIS-C or KD.
In this international cohort study, obesity was more prevalent for patients with MIS-C vs KD, and associated with more severe presentation, laboratory test features, and outcomes. These findings suggest that obesity as a comorbid factor should be considered at the clinical presentation in children with MIS-C.
HIV‐infected individuals with severe immunodeficiency are at risk of opportunistic infection (OI). Tuberculosis (TB) may occur without substantial immune suppression suggesting an early and sustained ...adverse impact of HIV on Mycobacterium tuberculosis (MTB)‐specific cell mediated immunity (CMI). This prospective observational cohort study aimed to observe differences in OI‐specific and MTB‐specific CMI that might underlie this. Using polychromatic flow cytometry, we compared CD4+ responses to MTB, cytomegalovirus (CMV), Epstein‐Barr virus (EBV) and Candida albicans in individuals with and without HIV infection. MTB‐specific CD4+ T‐cells were more polyfunctional than virus specific (CMV/EBV) CD4+ T‐cells which predominantly secreted IFN‐gamma (IFN‐γ) only. There was a reduced frequency of IFN‐γ and IL‐2 (IL‐2)‐dual‐MTB‐specific cells in HIV‐infected individuals, which was not apparent for the other pathogens. MTB‐specific cells were less differentiated especially compared with CMV‐specific cells. CD127 expression was relatively less frequent on MTB‐specific cells in HIV co‐infection. MTB‐specific CD4+ T‐cells PD‐1 expression was infrequent in contrast to EBV‐specific CD4+ T‐cells. The variation in the inherent quality of these CD4+ T‐cell responses and impact of HIV co‐infection may contribute to the timing of co‐infectious diseases in HIV infection.
Individuals with HIV infection are at increased risk of active tuberculosis (TB) even prior to advanced immunosuppression, unlike other opportunistic infections (OIs) e.g. cytomegalovirus (CMV), which tend to cause disease at defined later stages of immunosuppression. We found that CD4+ T‐cell specific responses to Mycobacterium tuberculosis differed in several key aspects from those to other OIs including frequency, functionality and phenotype. HIV co‐infection was associated with a paucity of CD4+ IFN‐γ and IL‐2‐dual secreting cells, pinpointing this as a key MTB‐specific T‐cell subset.
A pilot toxicology database system has been created which is accessible on-line via the world-wide web or in-house via an intranet. It is intended to be suitable as a source of toxicological ...information and to support structure–activity relationship studies, and it can be searched on chemical structural and substructural as well as toxicological and physico-chemical data. Successful completion of the pilot has led to an ongoing project to develop and expand the system.
The highly branched isoprenoid (HBI) alkenes of three batch cultures of the diatom Haslea ostrearia have been examined and the occurrence of C sub(25) tri-, tetra- and pentaenes confirmed. Growth of ...cultures outside at ambient temperature, under natural sunlight, in May (6 days) and June (10 days) 1995 and monitoring of HBI concentrations in samples collected daily and stored frozen, revealed that in May greater concentrations of HBIs (ca 6500 fg /cell) were produced than in June and at a much earlier stage of growth. Furthermore, in May the HBIs were more unsaturated (predominantly a tetraene rather than a triene). The reasons for these differences are at present unknown and future investigations of the effect of irradiance, temperature, salinity and other environmental variables are required. Such experiments may allow the various HBI distributions in the alga and in sediments to be better understood and, like some other polyunsaturated lipids, HBI alkenes may become useful environmental and palaeoenvironmental indicators. Two previously unreported alkenes, 2,6,10,14-tetramethyl-7-(3-methylpent-4-enyl)pentadec-2,5,9,13-ene (GC retention index, 2201 sub(DB-1)) and 2,6,10,14-tetramethyl-7-(3-methylene pent-4-enyl)pentadec-2,5,9,13-ene (GC RI, 2248 sub(DB-1)) from a batch culture of Haslea ostrearia grown in October/November 1993 and stored frozen for over a year, have also been isolated and characterised by super(13)C and super(1)H NMR, epoxide derivatisation and mass spectrometry. Such structural characterisation studies of HBI alkenes should also aid our understanding of the geochemical fate of these widely distributed hydrocarbons.
The present study examined the division of childcare among fathers diagnosed with substance use disorder and their non-substance-abusing partners, and how satisfaction with childcare responsibilities ...and with partners' parenting were related to relationship satisfaction. Mothers reported more responsibility for the supervision of children's activities and arranging for childcare, but there were no differences between parents on transporting children to activities, taking care of children when they were ill, and taking time off to attend doctor's visits and school meetings. Satisfaction with their partners as parents predicted men's relationship satisfaction. Mothers' satisfaction with the division of childcare and their partners as parents predicted women's relationship satisfaction. Paternal involvement in childcare appears important for relationship satisfaction in two-parent families in which fathers have substance use disorder.
A peptide (S4) of the rat brain sodium channel has been synthesized, studied by high-resolution NMR and its secondary structure modelled by distance geometry and restrained molecular dynamics ...techniques.
Na- channel; Peptide, S4-; NMR; Peptide structure
The objective was to assess the extent and pattern of illness intrusiveness, one measure of quality of life, in subjects with bipolar disorder (BD) and to determine whether specific illness variables ...had influenced the degree of intrusiveness experienced. To compare findings from BD subjects relative to published findings for subjects with chronic medical conditions. The study involved the administration of a self-report assessment tool to euthymic outpatients with BD attending a university based hospital clinic. Of the 155 eligible participants, 112 completed a standardized psychiatric interview (SADS-L) and 87 of these met study criteria for euthymia and were approached to participate in the study. Sixty-eight completed self-report measures were returned. The main outcome measure was the Illness Intrusiveness Rating Scale (IIRS) which was analysed along with a composite measure of life events. It resulted that individuals' with BD experience significant illness intrusiveness into a number of life domains even after controlling for negative life events. Factors such as type of BD, the presence of a depressive episode in the preceding year and current Hamilton depression rating scale score contributed to the total illness intrusiveness. The degree of total illness intrusiveness experienced by individuals with BD was similar to that of subjects with multiple sclerosis and greater than subjects with end stage renal disease and rheumatoid arthritis. It seems apparent that quality of life, as determined by illness intrusiveness, is compromised in subjects with BD even during periods of euthymia. BD is at least as intrusive as several chronic medical conditions. Those with a type II BD report greater impairment in all domains compared with type I. Future research should determine specific psychosocial interventions aimed at reducing the impact of BD.
PTF10ops is a Type Ia supernova (SN Ia), whose lightcurve and spectral properties place it outside the current SN Ia subtype classifications. Its spectra display the characteristic lines of ...subluminous SNe Ia, but it has a normal-width lightcurve with a long rise-time, typical of normal luminosity SNe Ia. The early-time optical spectra of PTF10ops were modelled using a spectral fitting code and found to have all the lines typically seen in subluminous SNe Ia, without the need to invoke more uncommon elements. The host galaxy environment of PTF10ops is also unusual with no galaxy detected at the position of the SN down to an absolute limiting magnitude of r \geq -12.0 mag, but a very massive galaxy is present at a separation of ~148 kpc and at the same redshift as suggested by the SN spectral features. The progenitor of PTF10ops is most likely a very old star, possibly in a low metallicity environment, which affects its explosion mechanism and observational characteristics. PTF10ops does not easily fit into any of the current models of either subluminous or normal SN Ia progenitor channels.
Two‐dimensional 1H‐NMR methods have been used to assign heme and amino acid proton resonances in both isomeric states of the carbon monoxide complexes of two Glycera dibranchiata monomeric ...hemoglobins, HbA and HbB. For each hemoglobin, there are small differences in heme pocket structure in the two isomeric forms. The largest structural perturbations associated with heme isomerism involve residues close to pyrrole rings I and II. The positions relative to the heme of phenylalanine CD1 and the proximal histidine ligand are almost unaffected by heme isomerism. These residues probably play a key role in determining the location of the heme within the heme pocket.
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