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Introduction: Pimavanserin is approved in the USA to treat hallucinations and delusions associated with Parkinson's disease psychosis (PDP). Objectives: We evaluated mortality in patients with PDP after initiation of pimavanserin or comparator atypical antipsychotics, overall, over time, and across subgroups. Methods: A cohort of patients aged ≥65 years in the USA with PDP newly initiating pimavanserin or a comparator atypical antipsychotic (clozapine, quetiapine, risperidone, olanzapine, aripiprazole, brexpiprazole) was identified in 2016–2019 Medicare claims data. All-cause mortality in the propensity score–matched treatment groups was compared with hazard ratios (HRs) and 95% confidence intervals (CIs) estimated with Cox-proportional hazards models. Cumulative incidence curves and time period–specific models evaluated risk over time. Subgroup and sensitivity analyses were performed, including a sub-cohort of long-term care (LTC) or skilled nursing facility (SNF) residents. Results: We identified 2892 pimavanserin initiators and 19,083 comparator initiators (overall 47% female, mean age = 80.9 years, LTC/SNF residents = 30%). Before matching, pimavanserin users had fewer severe comorbidities and more anti-Parkinson medication use than comparators. Matching resulted in 2891 patients in both groups, and all covariates were well balanced. In the matched cohort, the HR for mortality for pimavanserin versus comparator was 0.78 (95% CI 0.67–0.91), with the lowest time period–specific HRs in the first 180 days. Hazard ratios were similar across sensitivity analyses and subgroups. In LTC/SNF residents, the HR was 0.78 (95% CI 0.60–1.01). Conclusion: The observed mortality rates were lower among patients treated with pimavanserin compared with those treated with other atypical antipsychotics. Study registration: European Union Post-authorization Study (EU PAS) register number 46331. [ABSTRACT FROM AUTHOR]

Background: Parkinson's disease-related psychosis increases patients' risk of falls. Pimavanserin is an atypical antipsychotic approved in the USA in 2016 for the treatment of hallucinations and delusions associated with Parkinson's disease-related psychosis. Objective: We aimed to compare the risk of falls/fractures among patients with Parkinson's disease-related psychosis treated with pimavanserin vs other atypical antipsychotics. Patients and Methods: We identified a cohort of patients with Parkinson's disease-related psychosis aged ≥ 40 years initiating either pimavanserin or a comparator antipsychotic (clozapine, quetiapine, risperidone, olanzapine, aripiprazole, brexpiprazole) in US commercial insurance and supplementary Medicare claims (2015–2019). Comparators were propensity score matched 2:1 with pimavanserin initiators; incidence rates of falls/fractures were compared using incidence rate ratios (IRRs) and 95% confidence intervals (CIs). Results: We identified 112 eligible pimavanserin initiators and 982 comparators. Pimavanserin initiators were younger and had fewer severe comorbidities, indicators of impairment, and healthcare encounters, though they had higher Parkinson's disease medication use. The crude incidence rates [cases/100 person-years] (95% CI) for composite falls/fractures were 17.8 (7.7–35.0) for pimavanserin and 40.8 (35.0–47.4) for comparators. Matching retained 108 pimavanserin initiators and 216 comparators—all characteristics were well balanced after matching—with a matched IRR (pimavanserin vs comparator) of 0.71 (95% CI 0.27–1.67). Sensitivity analysis IRR estimates were consistently below 1.00, with a sensitivity analysis not requiring a diagnosis of psychosis resulting in an IRR estimate of 0.55 (95% CI 0.34–0.86). Conclusions: The results of this study do not suggest an increase in the risk of falls or fractures associated with pimavanserin compared with other antipsychotics in patients with Parkinson's disease-related psychosis. Sensitivity analyses suggest a decreased risk. [ABSTRACT FROM AUTHOR]

Multidetector computed tomography (MDCT) has emerged as the imaging modality of choice for evaluating the abdomen and pelvis in trauma patients. MDCT readily detects injury of the solid organs as well as direct and indirect features of bowel and/or mesenteric injury-an important advance given that unrecognized bowel and mesenteric injuries may result in high morbidity and mortality. Nonetheless, challenges persist in the interpretation of abdominal and pelvic CT images in trauma patients. Difficulty in interpretation may result from lack of familiarity with or misunderstanding of CT features of bowel and/or mesenteric injury. Moreover, due to major technical advances afforded by MDCT, new CT features of bowel and/or mesenteric injuries have been recognized. Beading and termination of mesenteric vessels indicating surgically important mesenteric injury is an example of one of these new features. MDCT also allows for the detection of small or trace amounts of isolated intraperitoneal fluid in trauma patients, although the clinical management of these patients is still controversial. This pictorial essay illustrates the spectrum of typical, atypical, and newly reported MDCT features of bowel and mesenteric injuries due to blunt trauma. The features that help to differentiate these injuries from pitfalls are emphasized in these proven cases. [ABSTRACT FROM AUTHOR]

Multiparametric-MRI is an important tool in the diagnosis of prostate cancer (PCa), particularly diffusion-weighted imaging for peripheral zone (PZ) cancer in the untreated prostate. However, there are many benign entities that demonstrate diffusion restriction in the PZ mimicking PCa resulting in diagnostic challenges. Fortunately, these benign entities usually have unique MR features that may help to distinguish them from PCa. The purpose of this pictorial review is to discuss benign entities with diffusion restriction in the PZ and to emphasize the key MR features of these entities that may help to differentiate them from PCa. [ABSTRACT FROM AUTHOR]

Morbid obesity remains as a common and increasing health problem. Due to limited long-term success with nonsurgical weight loss measures for morbid obesity, bariatric surgery is being performed more and more often in both academic and private practice settings and has proven to be an effective treatment option with sustained weight loss, decreased morbidity, reversal of comorbidities, and prolonged life expectancies [Am J Clin Nutr 55:615S-619S, ; Brolin, Nutrition 12:403-404, ; Fisher and Schauer, Am J Surg 184:9S-16S ]. The Roux-en-Y gastric bypass, biliopancreatic diversion, and gastric sleeve will be discussed in terms of their expected imaging appearance and potential complications. [ABSTRACT FROM AUTHOR]

In mammals, S-adenosylhomocysteine hydrolase (AdoHcyase) is the only known enzyme to catalyze the breakdown of S-adenosylhomocysteine (AdoHcy) to homocysteine and adenosine. AdoHcy is the product of all adenosylmethionine (AdoMet)-dependent biological transmethylations. These reactions have a wide range of products, and are common in all facets of biometabolism. As a product inhibitor, elevated levels of AdoHcy suppress AdoMet-dependent transmethylations. Thus, AdoHcyase is a regulator of biological transmethylation in general. The three-dimensional structure of AdoHcyase complexed with reduced nicotinamide adenine dinucleotide phosphate (NADH) and the inhibitor (1′R, 2′S, 3′R)-9-(2′,3′-dihyroxycyclopenten-1-yl)adenine (DHCeA) was solved by a combination of the crystallographic direct methods program, SnB, to determine the selenium atom substructure and by treating the multiwavelength anomalous diffraction data as a special case of multiple isomorphous replacement. The enzyme architecture resembles that observed for NAD-dependent dehydrogenases, with the catalytic domain and the cofactor binding domain each containing a modified Rossmann fold. The two domains form a deep active site cleft containing the cofactor and bound inhibitor molecule. A comparison of the inhibitor complex of the human enzyme and the structure of the rat enzyme, solved without inhibitor, suggests that a 17° rigid body movement of the catalytic domain occurs upon inhibitor/substrate binding. [ABSTRACT FROM AUTHOR]

Mineralization of N from organic materials added to soil depends on the quality of the substrate as a carbon, energy and nutrient source for the saprophytic microflora. Quality reflects a combination of biochemical and physical attributes. We investigated how biochemical composition interacts with particle size to affect the soil microflora and N dynamics following incorporation of crop residues into soil. Four fresh shoot and root crop residues were cut into coarse and fine particle sizes, and incorporated into sandy-loam soil which was incubated under controlled environment conditions for 6 months. In the case of the highest biochemical quality material, potato shoot (C/N ratio of 10 : 1), particle size had no effect on microbial respiration or net N mineralization. For lower biochemical quality Brussels sprout shoot (C/N ratio of 15 : 1), reducing particle size caused microbial respiration to peak earlier and increased net mineralization of N during the early stages of decomposition, but reduced net N mineralization at later stages. However, for the lowest biochemical quality residues, rye grass roots (C/N ratio of 38 : 1) and straw (C/N ratio of 91 : 1) reducing particle size caused microbial respiration to peak later and increased net immobilization of N. For Brussels sprout shoot, reducing particle size decreased the C content and the C/N ratio of residue-derived light fraction organic matter (LFOM) 2 months following incorporation. However C and N content of LFOM derived from the other materials was not affected by particle size. For materials of all qualities, particle size had little effect on biomass N. We conclude that the impact of particle size on soil microbial activities, and the protection of senescent microbial tissues from microbial attack, is dependant on the biochemical quality of the substrate. [ABSTRACT FROM AUTHOR]

Computed tomography (CT) is a fast and accurate way to evaluate patients with acute right lower abdominopelvic pain. In the emergency setting, appendicitis is the most common etiology. A tailored CT examination can visualize the normal or abnormal appendix with accuracy, confirming or excluding appendicitis in 90-95% of cases. If the appendix is normal, CT often identifies an alternative etiology for the pain. This exhibit reviews the CT appearance of the normal appendix, usual and unusual presentations of appendicitis and complicated appendicitis, and pitfalls in diagnosis. The CT appearance of other conditions included in the differential diagnosis of acute right lower quadrant pain and clinically mimicking appendicitis is also presented, including disorders arising from the gastrointestinal tract, genitourinary tract, and vascular and musculoskeletal systems. [ABSTRACT FROM AUTHOR]

Esophageal intramural pseudodiverticulosis (EIP) is a rare condition of unknown etiology. It is characterized by multiple, small, flaskshaped outpouchings in the esophageal wall. Involvement may be segmental or diffuse. Since this entity was first reported in 1960, there have been 43 cases described in the English literature. These cases are reviewed and six additional cases are reported with emphasis on clinical and radiographic parameters of this entity. [ABSTRACT FROM AUTHOR]

Perforation of the hypopharynx, esophagus, and stomach complicated the insertion of flexible tubes in 11 adults. Nasogastric suction tubes were responsible for 5 instances of gastric perforation. Palliative intubation of obstructive carcinomas of the distal esophagus resulted in delayed perforation of the esophagus and stomach in 2 cases. The use of a Linton tube for decompression of bleeding varices caused esophageal rupture in 1 patient whereas 2 others developed pharyngoesophageal perforation due to misplaced endotracheal tubes. The remaining 1 case demonstrated penetration of a chest tube into the esophageal lumen. The radiographic features and mechanisms of these iatrogenic injuries are described and the pertinent literature is reviewed. [ABSTRACT FROM AUTHOR]

To determine the effects of anemia in children with end-stage renal disease, we studied cardiac performance before and 1 and 6 months after recombinant erythropoietin (Epogen). Children with end-stage renal disease were included if they had significant anemia [hematocrit (Hct)<30%]. Epogen 50 U/kg was given subcutaneously or intravenously three times per week until the Hct was ≥33%. Echocardiography, cardiac output (acetylene rebreathing), and treadmill (modified Bruce) tests were performed. Boys (9) and girls (9), 11.9±5.6 years, were given Epogen and the Hct increased (from 21.7±2.7% to 33.4±2.1%, P=0.001). Heart rate decreased ( P=0.04) and stroke volume did not change. Blood pressure did not change. Cardiac thickness, chamber dimensions, left ventricular wall stress, velocity of circumferential fiber shortening, and indices of diastolic function were normal and did not change after Epogen. Exercise time increased (from 10.3±1.9 to 11.2±1.9 min, P=0.01) after 1 month of Epogen. Resting oxygen consumption (VO) decreased (from 7.8±1.8 to 6.9±1.4 ml/min per kg, P=0.01) 1 month after Epogen and peak exercise VO did not change after Epogen. There were no differences in exercise tests between the 1 and 6 month measurements. Exercise tolerance improves after the short-term correction of anemia and there is no further improvement after long-term correction. [ABSTRACT FROM AUTHOR]

The radiological manifestations of four cases of polypoid carcinoma of the esophagus are reviewed. A large pedunculated intraluminal mass, mimicking a foreign body was seen in three of the four cases. Due to this predominant exophytic growth, the follow-up esophagogram was normal in two patients after radiotherapy, despite the very large size of the lesions. The unique histopathology and radiology of this entity are discussed. [ABSTRACT FROM AUTHOR]

We describe the clinical and pathological findings of the hemolytic uremic syndrome (HUS) in two children with human immunodeficiency virus (HIV) infection. Both patients presented with microangiopathic hemolytic anemia, thrombocytopenia, and subsequently developed renal failure. The diagnosis of HUS was confirmed by renal histopathology in both patients. None of these children presented with bloody diarrhea, evidence of circulating antibody response to Escherichia coli O157 lipopolysaccharide, or other known risk factors for HUS, except for the presence of HIV infection. Each patient was treated with intravenous plasma infusion and renal replacement therapy. Their clinical course was characterized by non-oliguria and lack of significant hypertension throughout the acute phase of the disease. Despite these favorable clinical parameters, both patients developed endstage renal failure. The etiology of this atypical HUS characterized by poor renal survival remains unknown and the role of HIV infection in its pathogenesis, although possible, is unclear. [ABSTRACT FROM AUTHOR]

We report a case of recurrent pancreatitis caused by a duodenal duplication cyst with aberrant pancreatic ductal communication in a $$2{\raise0.5ex\hbox{$\scriptstyle 1$}\kern-0.1em/\kern-0.15em\lower0.25ex\hbox{$\scriptstyle 2$}}$$ -year-old female who had been previously treated for duodenal atresia. The evaluation of the pancreas included a computed tomography scan, endoscopic retrograde cholangiopancreatography, intraoperative ultrasound, and intraoperative cholangiogram. In the setting of duodenal atresia, this case underscores the complex embryology of pancreatic, duodenal, and biliary development. Any infant with recurrent pancreatitis should have a complete evaluation in order to identify a potentially correctable lesion. The surgical options remain defined by the anatomy and include resection, marsupialization, or internal drainage. [ABSTRACT FROM AUTHOR]

Three cases of insulin-requiring diabetes mellitus associated with tacrolimus (FK506) therapy in pediatric renal transplant patients are presented. New-onset diabetes mellitus has been reported with tacrolimus therapy post liver and kidney transplants in up to 12% of adult patients, but is thought to be rare in pediatrics. Although insulin requirement with tacrolimus therapy has been occasionally reported in adolescent patients post liver transplant, only a single case in a pediatric kidney transplant recipient has been previously documented. These cases illustrate the significant diabetogenic effect of tacrolimus in pediatric renal transplant patients. As the use of tacrolimus becomes more prevalent in pediatric kidney transplantation, pediatric nephrologists should be aware of this potential complication. [ABSTRACT FROM AUTHOR]

Presents a case study of Candida albicans cholecystitis found in a male patient. Clinical history of the patient; Results of physical and laboratory examinations performed on the patient; Information on Candida albicans.