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Eating disorder and weight loss interventions have typically been regarded as distinct or antithetical, despite a growing number of individuals with comorbid eating pathology and obesity. This siloing of research and practice has created a clinical conundrum for providers seeking to treat individuals with an eating disorder seeking to lose weight (e.g., required pre-surgical weight loss). To date, integrated treatment research targeting both eating disorders and weight loss is rare and practical guidance is lacking, especially for restrictive/binge-purge subtypes. This case example describes how an integrated approach was applied within a naturalistic outpatient clinical practice setting to successfully treat a client presenting with excess weight and severe bulimia nervosa who was medically required to lose weight for orthopedic surgery. We conclude by reviewing the benefits and challenges of integrating eating disorder and behavioral weight loss treatments and providing practical insights for treatment providers.

OBJECTIVE This study examines how demographic factors (i.e., age, employment, or income) and personal life experiences (i.e., witnessing intimate partner violence [IPV] in childhood, number of violent partners, violence perpetration, or stressful life events) are related to IPV frequency across types of IPV (i.e., physical assault, psychological aggression, or sexual coercion) in a racially diverse sample. METHOD Participants included 126 women recruited from community organizations in the Mid-South, United States who experienced IPV in the past 6 months (Mage = 32.90, SD = 6.82). The majority of the sample self-identified as Black or African American (66%) and reported an annual income below $20,000 (73%). Three linear regressions were run to assess relations between age, employment status, annual income, witnessing IPV in childhood, number of violent partners, violence perpetration, and stressful life events for each type of IPV; all three models also accounted for the other forms of IPV. RESULTS Psychological aggression was significantly associated with a higher income as well as more frequent physical assault and sexual coercion. Physical assault was linked with younger age, lower income, not witnessing IPV in childhood, IPV perpetration, more psychological aggression, and more sexual coercion. Sexual coercion was associated with more stressful life events, having multiple violent partners, higher psychological aggression, and higher physical assault. CONCLUSIONS Results suggest that interventions should target mutable demographic factors and screen for personal life events to reduce IPV frequency and revictimization across types of IPV. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Do we preferentially learn from outcomes that confirm our choices? This is one of the most basic, and yet consequence-bearing, questions concerning reinforcement learning. In recent years, we investigated this question in a series of studies implementing increasingly complex behavioral protocols. The learning rates fitted in experiments featuring partial or complete feedback, as well as free and forced choices, were systematically found to be consistent with a choice-confirmation bias. This result is robust across a broad range of outcome contingencies and response modalities. One of the prominent behavioral consequences of the confirmatory learning rate pattern is choice hysteresis: that is the tendency of repeating previous choices, despite contradictory evidence. As robust and replicable as they have proven to be, these findings were (legitimately) challenged by a couple of studies pointing out that a choice-confirmatory pattern of learning rates may spuriously arise from not taking into consideration an explicit choice autocorrelation term in the model. In the present study, we re-analyze data from four previously published papers (in total nine experiments; N=363), originally included in the studies demonstrating (or criticizing) the choice-confirmation bias in human participants. We fitted two models: one featured valence-specific updates (i.e., different learning rates for confirmatory and disconfirmatory outcomes) and one additionally including an explicit choice autocorrelation process (gradual perseveration). Our analysis confirms that the inclusion of the gradual perseveration process in the model significantly reduces the estimated choice-confirmation bias. However, in all considered experiments, the choice-confirmation bias remains present at the meta-analytical level, and significantly different from zero in most experiments. Our results demonstrate that the choice-confirmation bias resists the inclusion of an explicit choice autocorrelation term, thus proving to be a robust feature of human reinforcement learning. We conclude by discussing the psychological plausibility of the gradual perseveration process in the context of these behavioral paradigms and by pointing to additional computational processes that may play an important role in estimating and interpreting the computational biases under scrutiny.

Purpose To demonstrate that left radial access for diagnostic cerebral angiography with Extra backup and 4F vertebral catheters is feasible and safe. Materials and methods This study is a retrospective review of our prospective database on left radial access for cerebral angiography procedures, using an extra backup catheter associated with a 4Fr vertebral catheter, performed between March and September 2019. Patient demographics, procedural and radiographic metrics as well as clinical data were recorded. Results Seventy five patients with mean age of 51 years (range 21−73) underwent 80 cerebral angiographies. An average of four vessels were catheterized and mean fluoroscopy times per subject and vessel were was of 13.9 and 3.3 min, respectively. One patient required crossover to transfemoral access because of radial artery spasm. There were one asymptomatic distal radial artery occlusion and one patient presenting with asymptomatic skin blanching area on the forearm, just proximal to the tip of the sheath, that spontaneously resolved within an hour. Conclusion Diagnostic cerebral angiography via left radial access is feasible and safe and allows to preserve the right radial access for future neurointerventions while providing more comfort to the right handed patient.

Analytical solutions for geosynthetic reinforced fills over a void have appeared in the literature starting in the 1980s. Current solutions pay little or no attention to the influence of the creep-reduced stiffness of the geosynthetic reinforcement under tensile loading. This paper addresses this gap by introducing a reinforcement stiffness limit state in the design of these systems. The choice of reinforcement stiffness is based on a simple two-parameter hyperbolic isochronous load–strain model developed by the authors and applied to a large database of uniaxial and biaxial geogrids and woven geotextiles. The paper provides a design chart procedure that can be used with four well-known analytical solutions to compute the maximum reinforcement load. In addition to the stiffness limit state, the design chart approach includes vertical deformation and reinforcement strain serviceability limit states, and a tensile strength limit state. A novel feature of the design charts is a quantitative link to the ultimate strength of the reinforcement to estimate the isochronous stiffness of the reinforcement for different elapsed loading times and strains. There are many instances in the literature where the reinforcement stiffness was taken from a constant rate-of-strain tensile test. The paper shows that this is non-conservative for design.

Background: Methadone maintenance treatment (MMT) is an effective treatment for opioid use disorder. However, subtherapeutic dosing may lead to continued opioid use by failing to suppress opioid withdrawal and craving. Preclinical and pilot experimental research suggests that cannabinoids may reduce opioid withdrawal and craving. We sought to test whether the association between low methadone dose and illicit opioid use differs according to concurrent cannabis use patterns. Methods: Data for this study were derived from two community-recruited cohorts of people (≥18 years old) who use illicit drugs in Vancouver, Canada. We used generalized estimating equations to estimate the adjusted association between lower daily MMT dose (

Introduction: Cannabis products containing delta-8-THC became widely available in most of the United States in late 2020 and rapidly became a significant source of revenue for hemp processing companies, especially in states where use of delta-9-THC remains illegal or requires professional authorization for medical use. Scientific research on the use of delta-8-THC is scarce, previous clinical studies included a combined total of 14 participants, leading some state governments to prohibit it until its properties and effects are better understood. Methods: Researchers developed an online survey for delta-8-THC consumers addressing a broad range of issues regarding delta-8-THC, including use for the treatment of health and medical conditions. Previous survey studies on the medical use of cannabis and cannabis products informed survey components. Results: Patterns of delta-8-THC use had both similarities with and differences from the use of delta-9-THC cannabis and products. Administration methods were primarily edibles (64%) and vaping concentrates (48%). About half of the participants (51%) used delta-8-THC to treat a range of health and medical conditions, primarily anxiety or panic attacks (69%), stress (52%), depression or bipolar disorder (46%), and chronic pain (41%). Participants compared delta-8-THC very favorably with both delta-9-THC and pharmaceutical drugs and reported substantial levels of substitution for both. Most participants did not inform their primary care provider of their delta-8-THC use (78%) and were not confident of their primary care provider's ability to integrate medical cannabis into their treatment (70%). Knowledge of effective dosages was low, and participants' knowledge of delta-8-THC was primarily from the Internet and their own experiences. Conclusion: Harm reduction is a central component of public health. Although the legal environment is becoming more restrictive for delta-8-THC in comparison to delta-9-THC, results suggest that delta-8-THC may be equally effective for desired purposes of cannabis use and lower in undesirable or adverse effects. All policies and practices should be informed by empirical evidence. Considerable research will be needed to systematically verify the patterns reported by participants, and collaborations among academic researchers, government, and the cannabis industry may be valuable in developing the knowledge base for delta-8-THC and other cannabinoids.

Abstract. Chronic, systemic inflammation, which is associated with obesity and numerous other diseases, impairs iron status by increasing hepcidin concentration. Inflammation also decreases the concentration of transferrin, the main iron transport protein and a negative acute phase protein, which is indirectly assessed by measuring total iron binding capacity (TIBC). However, the contribution of diet-induced inflammation has not been studied. Data from two studies, namely Diet and Inflammation and Selenium and Inflammation Studies (total n=98) were used to assess the associations among Dietary Inflammatory Index (DII®) scores derived from three-day dietary records, body mass index (BMI=weight[kg]/height[m]2), inflammatory and hematological markers among young adults with normal-weight, overweight or obesity. Subjects’ diets were also categorized as less inflammatory diets (LID) and inflammatory diets (ID) using cluster analysis. Independent t-test and regression analyses were used to assess associations in the data. Intakes of iron, proteins, fat, fiber, and calories were higher in the LID group compared to the ID group (p0.05). Higher DII score was associated with increasing CRP (β+SE=0.23+0.07, p=0.002) and lower TIBC (β+SE=−8.46+3.44, p=0.02), independent of BMI category. The LID diet was associated with higher TIBC (β+SE=29.87+10.75, p=0.007) compared to the ID diet. In conclusion, inflammatory diets may impair iron status by reducing the iron binding capacity of transferrin.

Objective To investigate subclinical choroidal involvement in patients with systemic coronavirus disease 2019 (COVID-19) infection and evaluate its long-term course. Materials and Methods This prospective, longitudinal study included 32 eyes of 16 COVID-19 patients and 34 eyes of 17 age-matched healthy control subjects. All the participants had a detailed ophthalmologic assessment, including visual acuity assessment, slit-lamp examination, and indirect ophthalmoscopy. Enhanced depth optical coherence tomography imaging of the posterior pole and peripapillary region was performed in the early (days 15–40) and late (ninth month) postinfectious periods. Choroidal vascularity index (CVI) was calculated using ImageJ software (National Institutes of Health, Bethesda, Md.). Results None of the patients had any examination finding associated with the ocular involvement of COVID-19. Subfoveal choroidal thickness (SFCT) decreased significantly in the early postinfectious period compared with the healthy control individuals (p = 0.045). SFCT increased significantly in the late postinfectious period compared with the early period (p = 0.002), and the difference between patients and control individuals became statistically insignificant (p = 0.362). There was a similar trend for the peripapillary choroidal thickness measurements. CVI remained unchanged (p = 0.721) despite the significant decrease in SFCT and total choroidal area (p = 0.042), indicating that this decrease occurred both in choroidal stroma and in blood vessels. CVI remained unchanged in the late postinfectious period (p = 0.575) compared with the early period, indicating that recovery occurred in the entire choroidal tissue. Conclusion This study demonstrates that choroidal thickness was reduced in all measured areas and that this decrease affected all choroidal layers. This choroidopathy was reversible and recovered in the ninth postinfectious month.

Recent studies have extended the acquired preparedness model to experimental data, finding that impulsivity predicts subjective alcohol response, a related yet distinct construct from expectancies. However, studies have not tested whether specific facets of impulsivity predict subjective response, or whether impulsivity indirectly predicts alcohol craving through subjective response. Young adults who reported past-month binge drinking (N = 448) participated in a placebo-controlled alcohol administration study. Mediation models tested whether UPPS-P impulsivity facets indirectly predicted alcohol craving through subjective response on the ascending and descending limbs of the blood alcohol content (BAC). High arousal positive (e.g., sociable), low arousal positive (e.g., relaxed), high arousal negative (e.g., rude), and low arousal negative (e.g., dizzy) subjective effects were measured across limbs. Moderation by beverage condition was not detected, so models were collapsed across beverage condition. Sensation seeking indirectly predicted craving through high arousal positive subjective response on both limbs, whereas positive and negative urgency directly predicted craving. When controlling for baseline subjective response and craving, effects of sensation seeking and negative urgency on subjective response and craving became nonsignificant. The effects of positive urgency on craving remained, and an effect of positive urgency on high arousal positive effects emerged on the ascending limb. Findings suggest that relations among impulsivity, subjective response, and craving are contingent upon the specific facet of impulsivity. Interventions targeting predrink cue exposure and/or positive emotionality may be most effective for sensation seekers, whereas targeting subjective response and/or expectancies may be most efficacious for individuals high in positive urgency. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The localization and segmentation of the novel coronavirus disease of 2019 (COVID-19) lesions from computerized tomography (CT) scans are of great significance for developing an efficient computer-aided diagnosis system. Deep learning (DL) has emerged as one of the best choices for developing such a system. However, several challenges limit the efficiency of DL approaches, including data heterogeneity, considerable variety in the shape and size of the lesions, lesion imbalance, and scarce annotation. In this article, a novel multitask regression network for segmenting COVID-19 lesions is proposed to address these challenges. We name the framework MT-nCov-Net. We formulate lesion segmentation as a multitask shape regression problem that enables partaking the poor-, intermediate-, and high-quality features between various tasks. A multiscale feature learning (MFL) module is presented to capture the multiscale semantic information, which helps to efficiently learn small and large lesion features while reducing the semantic gap between different scale representations. In addition, a fine-grained lesion localization (FLL) module is introduced to detect infection lesions using an adaptive dual-attention mechanism. The generated location map and the fused multiscale representations are subsequently passed to the lesion regression (LR) module to segment the infection lesions. MT-nCov-Net enables learning complete lesion properties to accurately segment the COVID-19 lesion by regressing its shape. MT-nCov-Net is experimentally evaluated on two public multisource datasets, and the overall performance validates its superiority over the current cutting-edge approaches and demonstrates its effectiveness in tackling the problems facing the diagnosis of COVID-19.

Diabetic mellitus is a worldwide endocrine and metabolic disorder with insulin insensitivity or deficiency or both whose prevalence could rise up to 592 million by 2035. Consistent hyperglycemia leads to one of the most common comorbidities like Diabetic Peripheral Neuropathy (DPN). DPN is underlined with unpleasant sensory experience, such as tingling and burning sensation, hyperalgesia, numbness, etc. Globally, 50-60% of the diabetic population is suffering from such symptoms as microvascular complications. Consistent hyperglycemia during DM causes activation/inhibition of various pathways playing important role in the homeostasis of neurons and other cells. Disruption of these pathways results into apoptosis and mitochondrial dysfunctions, causing neuropathy. Among these, pathways like Polyol and PARP are some of the most intensively studied ones whereas those like Wnt pathway, Mitogen activated protein kinase (MAPK), mTOR pathway are comparatively newly discovered. Understanding of these pathways and their role in pathophysiology of DN underlines a few molecules of immense therapeutic value. The inhibitors or activators of these molecules can be of therapeutic importance in the management of DPN. This review, hence, focuses on these underlying molecular mechanisms intending to provide therapeutically effective molecular targets for the treatment of DPN.

Inflammatory pseudotumor (IPT) is a rare benign tumor of unknown etiology that can occur in almost any organ system. It has neoplastic features such as local recurrence, invasive growth, and vascular invasion, leading to the possibility of malignant sarcomatous changes. The clinical presentations of colonic IPT may include abdominal pain, anemia, a palpable mass, and intestinal obstruction. A few cases of colonic IPT have been reported, but colonic IPT with pedunculated morphology is very rare. Furthermore, since it can mimic malignant polyps, understanding the endoscopic findings of colonic IPT is important for proper treatment. Herein, we present a case of colonic IPT with pseudosarcomatous changes, presenting as a large polyp, mimicking a malignant polyp in the cecum, along with a literature review.

Patients with angiotensin-converting enzyme inhibitor (ACEI)-induced angioedema (ACEIIA) may visit family physicians. The aim of this article was to describe a case of delayed-onset ACEIIA and to present a concise scoping review. Using a case report and a scoping review study design, we report a case of ACEIIA, with clinically confirmed diagnosis. The symptoms resolved after replacing the offending ACEI with another antihypertensive agent. After excluding other causes of perioral swelling and discontinuation of ACEI, the patient was symptom-free within a few days thereafter. Based on this case presentation, we performed a meta-narrative scoping review including up-todate diagnosis and management of ACEIIA, based on published data in English, French, and German from inception to April 1, 2021. Patients with angioedema of unknown origin should be cautiously examined to rule out oral diseases, including allergy to dental materials and drug-induced angioedema. Clinicopathological aspects and current treatment guidelines for ACEI-associated angioedema are also presented.

Background Parkinson's disease (PD) caregivers, particularly in Latin America, may experience high levels of affiliate stigma due to their association with a person having a disability. The most common measure used of this construct in the literature, the Affiliate Stigma Scale, was validated using non-standard and questionable methods. Objective The purpose of this study was to investigate the factor structure and psychometric properties of the Spanish version of the Affiliate Stigma Scale with PD caregivers in Mexico using more widely accepted psychometric approaches including confirmatory and exploratory factor analyses (confirmatory factor analyses (CFAs) and exploratory factor analyses (EFAs)). Methods A sample of 148 PD caregivers from Mexico completed this measure, as well as indices of caregiver burden and anxiety. Results Initial CFAs revealed that the data did not fit either the originally proposed one-factor or three-factor structures. An EFA was then conducted which was unable to discern any factor structure. Upon instituting a stepwise removal alpha-if-item-deleted process, a 5-item Affiliate Stigma Scale Spanish Short Form was retained with an adequate Cronbach's alpha, good convergent validity, and a Short Form CFA generally indicating adequate fit. Conclusions The new Spanish Affiliate Stigma Scale Short Form holds promise for more appropriately measuring affiliate stigma likely in general but particularly in Spanish and among PD caregivers. The Short Form can assist not only in assessing levels of caregiver affiliate stigma, but in creating novel interventions to help support caregivers and decrease stigma.

The aim of this study is to investigate the ongoing energy management and energy efficiency practices in the industries of Peshawar division of Khyber Pakhtunkhwa, Pakistan. The outcomes of this research shows that Khazana Sugar Mills, Caliph Pharmaceutical, Naguman Flour Mill have no or low awareness of energy management practices (awareness level mainly includes barriers to energy efficiency and drivers for energy efficiency) except FF steel mill. The major paces observed in lacking the awareness are (1) “understanding level of staff and workers about energy savings due to energy management practices” (2) “interest level of top managers for energy management implementation” (3) “awareness level regarding energy efficiency” (4) “lack of technical competence” (5) “use of standardized procedures”. When the industry managers were inquired about the relationship with energy service providers it is found that there is absolute absence of energy engineers, relationship with energy consultancies and long-term energy strategy in all the industries. It was also found that there is lack of using renewable energy technologies in all industries as they were relying upon using the generators during the blackout hours. In terms of percentage, the energy saving factor of 36 kWh/day has also observed with the replacement of fluorescent tube lights with light emitting diode (LED) tube lights. Proper maintenance and energy management practices in the heating, ventilation and air conditioning system (HVAC) would also save energy in a significant amount. The study shows that there is an overall improvement factor of 4% to 8% if the inclusion of energy management and energy efficiency practices would have been applied in all the stated industries.

The awareness of the problem of sleep disorders among doctors does not protect this professional group against the condition. Being a doctor requires exceptional work skills under high pressure of responsibility for human life, the ability to cope with stress, work at night and the need to meet the requirement of continuous training. Studies have shown adverse health consequences for this occupational group, increased consumption of alcohol and drugs, as well as serious medical errors related to both sleep deprivation and night work. The aim of the publication is to discuss possible causes of sleep disorders in doctors and the multidimensional consequences of the problem.

Objective This study aims to examine the indications, techniques and outcomes of choledochoscopy during laparoscopic bile duct exploration and evaluate the results of the Wiper Blade Manoeuvre (WBM) for transcystic intrahepatic choledochoscopy. Summary background data Choledochoscopy has traditionally been integral to bile duct explorations. However, laparoscopic era studies have reported wide variations in choledochoscopy availability and use, particulary with the increasing role of transcystic exploration. Methods The indications, techniques and operative and postoperative data on choledeochoscopy collected prospectively during 1320 transcystic and choledochotomy explorations were analysed. The success rates of the WBM were evaluated for the 3 mm and 5 mm choledochocoscopes. Results Of 935 choledochoscopies, 4 were performed during laparoscopic cholecystectomies and 931 during bile duct explorations (70.5%); 486 transcystic choledochoscopies (52%) and 445 through choledochotomies (48%). Transcystic choledochoscopy was utilised more often than blind exploration (55.7%% vs 44.3%) in patients with emergency admissions, jaundice, dilated bile ducts on preoperative imaging, wide cystic ducts and large, numerous or impacted bile duct stones. Intrahepatic choledochoscopy was successful in 70% using the 3 mm scope and 81% with the 5 mm scope. Choledochoscopy was necessary in all 124 explorations for impacted stones. 20 retained stones (2.1%) were encountered but no choledochoscopy related complications. Conclusions Choledochoscopy should always be performed during a choledochotomy, particularly with multiple and intrahepatic stones, reducing the incidence of retained stones. Transcystic choledochoscopy was utilised in over 50% of explorations, increasing their rate of success. When attempted, the transcystic Wiper Blade Manoeuvre achieves intrahepatic access in 70-80%. It should be part of the training curriculum.

Objectives: The aim of this study was to evaluate serum lipid levels in patients under 50 years of agewith corneal arcus. Materials and Methods: This cross-sectional study was performed on patients under50 years of age referred to the ophthalmology clinic of Imam Reza Hospital in Ardabil who underwentcorneal arcus examination. Patients were enrolled in the study by census method.Information needed forpatients including age, sex, blood pressure, body mass index, history of smoking and alcohol consumption,history of serum lipid lowering drugs using, Xanthelasma, history of cardiovascular disease and history ofcerebrovascular events through history and examinationwere collectedby checklist.The collected data wereentered into SPSS version 22 software and then analyzed. Results: A total of 59 cases were included in thestudy. 36 (61%) of cases were male and 74.6% were overweight or obese. 50.8% of subjects had triglyceridesequal to or above 150 mg/dl. Additionally, 15.3% of cases with normal hyperlipidemia were using serumlipid-lowering drugs. There was no significant relationship between age and blood lipid levels (p> 0.05). Theprevalence of corneal arcus was higher at older ages and in people with a higher Body Mass Index (BMI), butthis association was not statistically significant. The intensity of corneal arcus was not significantly related toage, sex, serum lipid level and BMI (P> 0.05).Conclusion: The prevalence of corneal arcus increased withage. The prevalence of overweight, obesity and abnormal lipid profiles (specially triglyceride cholesterollevels) were remarkably but non-significantly high in our patients under 50 years of age with corneal arcus.

One of the commonest symptomatology in gynecological outpatient clinics is chronic pelvic pain, it accounts for 10% of gynecologist’s general clinics patients. The study aimed to To evaluate the role of laparoscopy in evaluation of CPP, and its correlation with clinical examination and vaginal ultrasound examination. The present prospective study was done in the Department of Obstetrics and Gynecology Salah Al-Deen general hospital in Tikrit city from 1stApril- 31st August 2020. The study sample consists of 30 patients with chronic pelvic pain, according to the ACOG criteria, with a convenient sampling method. The data collection done through: a designed closed and open-ended questionnaire, physical examination, transvaginal ultrasound & laparoscopic examination for the 30 patients for evaluation of chronic pelvic pain. By laparoscopic examination (90%) of patients had positive findings, pelvic examination identified (89%) of them correctly. Those with negative findings in laparoscopy was (10%) of patient, (33.3%) of them were diagnosed as negative by pelvic examination, there were miss diagnosis in (67%) of the negative patient and (11.1%) of positive diagnosed patient, this was a statically significant relation. Sensitivity of TVS was 85%, versus 89% for the pelvic examination. Specificity for TVS, and pelvic examination was (100%), (33%) respectively. Accuracy of the test for TVS, and pelvic examination was (87%), (83%) respectively. Exploratory laparoscopy provides a definitive diagnosis in 90% of women complaining of unexplained CPP. The surgical treatment of these lesions improves painful symptomatology in 70% of women .

Background: Chorea-acanthocytosis (ChAc) is the most common type of neuroacanthocytosis syndromes. Characteristic movement disorders of ChAc are choreiform movements affecting both trunk and extremities. Acanthocytosis in peripheral blood smear, elevated serum creatine kinase, atrophy of heads of caudate nuclei and dilation of the anterior horn of the lateral ventricles in magnetic resonance imaging could assist the diagnosis of ChAc. Objective: We aimed to report on the use of acupuncture to successfully improve ChAc symptoms. Method: A patient with definite ChAc was admitted, who had suffered from involuntary tongue protrusion for about 10 years. Acupuncture treatment was administrated for 3 times a week for 2 months. The chorea tremor control area, Baihui (GV20), Sishencong (EX-HN1), Shenting (GV24), Benshen (GB13, bilateral), Yintang (GV29), Neiguan (PC6, bilateral), Tongli (HT5, bilateral), Zusanli (ST36, bilateral), Sanyinjiao (SP6, bilateral), Dicang (ST4, bilateral), Chengjiang (CV24), Lianquan (CV23), Jinjin (EX-HN12) and Yuye (EX-HN13) were selected as acupunture points. Results: Previous drug dosage was reduced and the frequency of involuntary tongue protrusion was significantly reduced. Other clinical symptoms were also well controlled. Peripheral blood smear still indicated an increased proportion of red lineage, but blood analyses revealed improvement at follow-up. Conclusions: For patients who do not response well to conventional medical treatments, acupuncture might be used as an alternative treatment for symptoms related to ChAc.

Background Goldenhar syndrome is a rare congenital disorder. Limbal dermoid associated with this syndrome can cause high astigmatism and amblyopia in children. We report significant reduction in astigmatism, after limbal dermoid excision with lamellar keratoplasty, in a rare case of Goldenhar syndrome. Method A three-year-old female patient, with left-sided limbal dermoid with high astigmatism and amblyopia, was referred to us for visual rehabilitation. Results The patient had left-sided limbal dermoid and preauricular appendages. Oral examination revealed bifid labial frenum, a deep antegonial notch on the left side of the mandible and missing left upper central incisor teeth. She was diagnosed as a case of Goldenhar syndrome. Her best-corrected visual acuity was 20 of 20 in the right eye and 20 of 200 in the left eye. Refraction showed astigmatism of −10 diopters in her left eye. She underwent limbal dermoid excision with lamellar keratoplasty in her left eye, after which her astigmatism reduced considerably. Conclusions Early surgical intervention is recommended in cases of limbal dermoid with high astigmatism as it provides not only good cosmetic but also good visual benefits by early institution of treatment for amblyopia.

Statement of problem Porcelain laminate veneers without tooth preparation (no-prep veneers) might represent a convenient and conservative option for the esthetic rehabilitation of anterior teeth. However, controversy exists about their predictability. Purpose The purpose of this clinical study was to retrospectively evaluate the performance of no-prep porcelain veneers placed as per the recently proposed “CH no-prep” protocol, which claimed to overcome many of the drawbacks of previous no-prep veneer solutions. Material and methods One hundred eight no-prep porcelain laminate veneers based on the CH no-prep protocol were placed in 21 patients between 2015 and 2017. All participants were contacted, and 15 received a recall examination: a total of 78 veneers were evaluated as per the Clinical-Photographic-Micromorphologic coding. Plaque and gingival indexes and any increase in gingival recession were recorded. Pulp vitality was verified. A survival rate based on the count of absolute failures and a success rate summarizing the effect of both absolute and relative failures were calculated. Results The mean observation period was 43.1 months, with an observation interval of 36 to 60 months and a survival rate of 97.4%. From the 5 relative failures (3 minimal fractures or chips and 2 limited marginal discolorations) and the 2 absolute failures (unrepairable fractures), an overall success rate of 91.0% was recorded, with 71 restorations that were judged excellent in terms of clinical acceptance after the recall examination. From the Clinical-Photographic-Micromorphologic evaluation, 5 restorations (6.4%) showed minimal issues for marginal integrity, while a limited porcelain overhang was identified on 2 restorations (2.8%). Micromorphologic analyses confirmed the clinical evaluations. No periodontal recession was observed, and plaque and gingival indexes appeared stable. Conclusions Porcelain laminate veneers placed as per the CH no-prep protocol demonstrated excellent performances after 36 to 60 months of clinical service. The achieved outcomes, in terms of color match and overall esthetic and anatomic integration, confirmed that a prepless approach may be safely adopted provided that strict rules for patient selection and finish line placement are adopted.

Background Digital interventions for anxiety disorders are a promising solution to address barriers to evidence-based treatment access. Precise and powerful estimates of digital intervention effectiveness for anxiety disorders are necessary for further adoption in practice. The present systematic review and meta-analysis examined the effectiveness of digital interventions across all anxiety disorders and specific to each disorder v. wait-list and care-as-usual controls. Methods A systematic search of bibliographic databases identified 15 030 abstracts from inception to 1 January 2020. Forty-seven randomized controlled trials (53 comparisons; 4958 participants) contributed to the meta-analysis. Subgroup analyses were conducted by an anxiety disorder, risk of bias, treatment support, recruitment, location and treatment adherence. Results A large, pooled effect size of g = 0.80 [95% Confidence Interval: 0.68–0.93] was found in favor of digital interventions. Moderate to large pooled effect sizes favoring digital interventions were found for generalized anxiety disorder (g = 0.62), mixed anxiety samples (g = 0.68), panic disorder with or without agoraphobia (g = 1.08) and social anxiety disorder (g = 0.76) subgroups. No subgroups were significantly different or related to the pooled effect size. Notably, the effects of guided interventions (g = 0.84) and unguided interventions (g = 0.64) were not significantly different. Supplemental analysis comparing digital and face-to-face interventions (9 comparisons; 683 participants) found no significant difference in effect [g = 0.14 favoring digital interventions; Confidence Interval: −0.01 to 0.30]. Conclusion The precise and powerful estimates found further justify the application of digital interventions for anxiety disorders in place of wait-list or usual care.

BackgroundFear is an evolutionary adaptive emotion that serves to protect the organism from harm. Once a threat diminishes, fear should also dissipate as otherwise fear may become chronic and pathological. While actual threat of the COVID-19 pandemic (i.e., number of infections, hospitalizations, and deaths) has substantially varied over the course of the pandemic, it remains unclear whether (subjective) fear has followed a similar pattern.MethodTo examine the development of fear of COVID-19 during the pandemic and investigate potential predictors of chronic fear, we conducted a large online longitudinal study (N = 2000) using the Prolific platform between April 2020 and June 2021. Participants were voluntary response samples and consisted of residents of 34 different countries. The Fear of the Coronavirus Questionnaire (FCQ) and several other demographic and psychological measures were completed monthly.ResultsOverall, we find that fear steadily decreased since April 2020. Additional analyses showed that elevated fear was predicted by region (i.e., North America > Europe), anxious traits, gender, risks for loved ones, general health, and media use.LimitationsThe interpretation of the results of this study is limited by the non-representativeness of the sample and the lack of data points between August 2020 and June 2021.ConclusionsThis study helps to characterize the trajectory of fear levels throughout the COVID-19 pandemic and establish several relevant predictors of increased fear.

Objective To investigate the effect of electromyography (EMG)-driven robotic therapy on the recovery of the hand in a stroke case lasting 9 years. Case An 18-year-old patient with hemiparesis due to the ischemic lesion was admitted to our clinic with hand impairment. Fifteen sessions (5 weeks x 3 times) of robotic rehabilitation were applied with the Hand of Hope. Average EMG (mV) of flexor digitorum superficialis (FDS) muscle, average force (N) and the rate of force development (RFD)(N/s) were also assessed before and after the treatment following the 5th and 10th sessions and at the end of treatment. Also, Fugl-Meyer Assessment of Upper Extremity Scale (FMU-UE), Motor Activity Log (MAL), Canadian Occupational Performance Score (COPM) and Visual Analog Scale (VAS) were used for assessment before and after the treatment. Results The average EMG measured from FDS increased from 0.093-0.133 mV. The average force and average RFD increased from 45.6-97.7 and from 135.6-172.6 respectively. While affected and/or unaffected side force ratio increased dramatically from 54%-82%, the FMA-UE score increased from 56-59. The MAL quality of use score increased from 3.93-4.13. Performance and satisfaction scores of COPM changed from 5.25-7.25 and 4.5-8.25 respectively. VAS score for fatigue changed from 6 to 4. Discussion The improvement achieved 9 years later with 15 sessions of rehabilitation suggests that improvement may be possible for chronic stroke patients.

Therapeutic mechanisms targeting multiple mental health disorders are key for providing treatment services with high-disparity, low-resource populations. Rumination, a cognitive response style, is a well-recognized transdiagnostic factor across disorders in the general population (Arditte et al., 2016; Nolen-Hoeksema, 1991). This study explored the influence of rumination, and mediational effect of mental health disorder, on Quality of Life among a sample of 585 Northern Plains Indian (NPI) women and men. Using secondary data from a Mood Disorder Assessment Validation study, parallel mediation path analyses indicated rumination did not have a direct influence on quality of life. However, rumination indicated higher anxiety (R² = .38, p < .001), depression (R² = .60, p < .001), and substance use symptoms (R² = .14, p < .001). As rumination increased, significant increases occurred in severity of symptoms reported for women and men for all diagnoses- but lower perceived quality of life occurred only in the presence of depressive symptoms (women, B = -28.19, p < .001; men, B = -20.15, p < .001). Significant differences arose between NPI women and men, with women reporting higher rumination, anxiety, and depression and men reporting higher substance use. Based on these results, rumination is useful as a transdiagnostic factor for NPIs, as rumination helped uncover maladaptive coping mechanisms among NPIs in the sample. In addition, quality of life assessments can help target maladaptive coping in treatment by taking a holistic view of well-being that accounts for risk factors while supporting traditional views of healing. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Background Neuropathic pain (NeP) is pain provoked by damage or disease in the nervous system and about one in three Japanese patients with spinal disorders are highly likely to have NeP. The humanistic and economic burden of illness (BOI) of spine-related NeP represents unmet medical needs that should be addressed. The purpose of this targeted literature review was to synthesize the available evidence on the BOI of spine-related NeP in Japanese patients. Methods PubMed and ICHUSHI were searched for relevant studies published between January 2010 and December 2020, in English or Japanese. The population included patients with one or more of prespecified spinal disorders and NeP, and outcomes of interest were data related to humanistic or economic burden. Results Out of 32 studies that assessed the BOI of spine-related disorders in Japan, only six specifically assessed spine-related NeP. Among these studies, five different validated questionnaires were used to measure humanistic burden. Spine-related NeP was consistently shown to be related with a poorer health-related quality of life and higher levels of anxiety and depression compared to the general population as well as patients with nociceptive pain. No articles directly evaluating economic burden were identified in this search, so an exploratory analysis was conducted. Reduction in work productivity by people experiencing spine-related NeP in the whole of Japan were estimated to total JPY 172,266,780,480 per year. Conclusions The humanistic burden of spine-related NeP on Japanese patients is considerable, not only physically but also mentally. Exploratory analysis of the economic burden illustrates the possibility of substantial societal costs associated with NeP. In order to better understand the depth of BOI and the unmet medical need caused by spine-related NeP, further studies on real-world outcomes are recommended.

Objective Posttraumatic stress disorder (PTSD) is associated with impaired parenting, child mental health problems, and family dysfunction. Public service agencies, such as child welfare, may serve as critical points of entry to services for families impacted by caregiver PTSD; however, assessment of trauma and PTSD among caregivers is not always systematically incorporated into service planning. The Structured Trauma-Related Experiences and Symptoms Screener for Adults (STRESS-A) was developed to address barriers to screening and assessment by providing an easy-to-administer tool for use by clinically and nonclinically trained professionals. The current study evaluated the reliability and validity of the STRESS-A among fathers and mothers (N = 1245) referred by child protective services (CPS) to receive an intervention to reduce domestic violence. Methods Caregivers enrolled in the intervention completed the STRESS-A, along with measures of co-occurring mental health concerns. Results The STRESS-A demonstrated satisfactory internal reliability across the full sample and within maternal and paternal subsamples. Construct validity was supported by well-fitting models of the DSM-5 symptom structure. Convergent validity was supported by strong correlations with scores on measures of commonly occurring comorbid symptoms (e.g., depression, anxiety). Measurement invariance testing revealed that PTSD symptom factor loadings may not be equivalent between mothers and fathers when using the DSM-5 four-factor, DSM-IV three-factor, or one-factor models. Conclusion The study supports the STRESS-A as a reliable and valid tool for measuring PTSD symptoms in caregivers with current domestic violence and CPS involvement. Findings indicate further research investigating symptom structure differences between mothers and fathers. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Dural puncture is either diagnosed by unexpectedly profound response to medication test dose or development of a postpartum postural headache. Epidural blood patch is the gold standard for treatment of PDPH when conservative management fails. However, postpartum headaches can be resistant to multiple epidural blood patches. In such cases, preexisting intracranial processes should be considered and ruled out. We report here the unique case of a pregnant patient who developed a resistant headache in the postpartum period related to an incidental intracranial aneurysm. Subsequent treatment with endovascular embolization adequately relieved her symptoms. Early surgical consultation and a multidisciplinary team approach involving neurology and neuroimaging is required for successful management of patients such as the one described here.

A case study of the steel–concrete composite structure in the Pidie Jaya Regency Multipurpose Hall which experienced substantial permanent lateral deformation due to the effect of an earthquake is presented in this study. Therefore, it is important to assess the response of the structure to earthquake load and propose the strengthening strategies to make the buildings useful again. The purpose was to evaluate the causes of large deformations and the behavior of structure in resisting earthquake loads. The building structure model used in this study is a space frame with two-column base support conditions which are fixed and hinged supports after which a non-linear time history analysis was conducted. The time history analysis was conducted using five ground motion acceleration data recorded during earthquakes to determine the deformation and it was found that the large structure permanent deformation was due to the small structure stiffness in the direction of the deformation due to the use of only one column row in front of the building. Moreover, hinged support was observed to have caused a greater deformation than fixed support but was found not to be the main cause of large permanent deformation of the structure. The building structure was further strengthened by adding 4 columns while the oblique columns remained in a sloping condition. Meanwhile, the response spectrum analysis showed the strengthening structure was able to withstand earthquake loads with less deformation than the required standard.

Purpose To describe a case of bilateral cystoid macular edema in a patient with long-standing Tramadol hydrochloride use. Methods Observational case report. Results and discussion: A 73-year-old female patient was referred for progressive, bilateral decreased visual acuity. The patient was phakic with a best-corrected visual acuity (BCVA) at presentation was 20/50 on the right eye (RE) and 20/64 on the left eye (LE). The patient had a history of low back pain and had been on Tramadol hydrochloride 200 mg/day for 16 years. Bilateral cystoid macular edema (CME) was confirmed by means of multimodal imaging, including OCT angiography. Tramadol intake was progressively reduced over one month and then completely interrupted. At three months follow-up, the cystoid macular edema had completely resolved and BCVA improved in both eyes. Conclusion CME may be associated with longstanding treatment with Tramadol hydrochloride. Tramadol hydrochloride associated CME is described, as well as its resolution on Tramadol cessation.

Despite that convolutional neural networks (CNNs) have shown high-quality reconstruction for single image dehazing, recovering natural and realistic dehazed results remains a challenging problem due to semantic confusion in the hazy scene. In this article, we show that it is possible to recover textures faithfully by incorporating semantic prior into dehazing network since objects in haze-free images tend to show certain shapes, textures, and colors. We propose a semantic-aware dehazing network (SDNet) in which the semantic prior is taken as a color constraint for dehazing, benefiting the acquisition of a reasonable scene configuration. In addition, we design a densely connected block to capture global and local information for dehazing and semantic prior estimation. To eliminate the unnatural appearance of some objects, we propose to fuse the features from shallow and deep layers adaptively. Experimental results demonstrate that our proposed model performs favorably against the state-of-the-art single image dehazing approaches.

Purpose To report a case of syphilitic outer retinopathy revealed after progression to panuveitis following a course of oral steroids for suspected poison ivy. Methods Retrospective case report. Results A 44-year-old diabetic man presented with progressive symptoms of nyctalopia and color vision changes associated with outer retinal disruption on macular imaging but minimal evidence of intraocular inflammation on examination. A short-course of oral steroids for an unrelated skin condition induced rapid progression to frank panuveitis with retinal vascular sheathing and retinal whitening. Systemic work-up identified syphilis as the etiology. The patient's visual symptoms and disruption of the photoreceptor and retinal pigment epithelial layers on OCT improved after treatment with intravenous penicillin. Conclusion Syphilitic outer retinopathy (SOR) represents an unusual manifestation of ocular syphilis that can present with minimal exam findings. We present here a case of oral steroid use resulting in progression of SOR to a more fulminant form of syphilitic uveitis which ultimately revealed the correct diagnosis and prompted the correct intervention. This case highlights the importance of maintaining a high level of suspicion for this treatable condition.

The regional techniques for axillary analgesia are well established. However, few studies have investigated surgical anesthesia. In this report, extensive debridement of axillary necrotizing fasciitis, including the posteromedial region of the right arm, performed under exclusive regional anesthesia in a patient with probable difficult airway is described. The procedure was performed under a Serratus Plane Block (SPB) and supraclavicular brachial plexus block, guided by ultrasound, and performed with venous sedation. We observed satisfactory anesthesia 15-minutes after the intervention and efficient intraoperative pain control within the following 24 hours. Surgical axilla anesthesia is feasible with the described blocks.

Bacterial keratitis is one of the widely used infection of the eye and usually treated with antibacterial eye drops. In complicated infection more than one eye drop is needed. Several problems arise from using eye drops such as frequent instillation and low patient compliance. The aim of the research is to formulate an ocular insert that have the ability to delivery two drugs at the same time with sustained release pattern. Several formulations were used utilizing HPMC K15M as the main polymer with polyvinyl pyrrolidone k30, Carbopol 934, sodium carboxymethyl cellulose and Ethyl cellulose as polymer blends, propylene glycol as plasticizer and levofloxacin and tinidazole as antibacterial agents. Different formulation were prepared using solvent casting method and evaluated for their weight variation, thickness, drug content, pH, in-vitro drug release and kinetics. The formula with 1:1 HPMC K15M :Carbopol 934 was chosen as the optimum formula which showed proper physical properties and had the proper strength and mucoadhesion with high swelling index and sustained release of both drugs for around 12 h. When examined in animals no irritation was observed and also the drug remain in ocular tissues for a long period. Levofloxacin and tinidazole were successfully formulated as solid insert and sustained the release of both drugs for around 24 h. The approach of solid insert is promising approach to overcome problems with topical ocular delivery.

This study investigated the effects of replacing fishmeal with Clostridium autoethanogenum protein (CAP) on growth, feed utilization and intestinal histology of largemouth bass (Micropterus salmoides). The control diet contained 350 g/kg fishmeal, and then dietary fishmeal was decreased to 300 g/kg, 250 g/kg, 200 g/kg, 150 g/kg and 100 g/kg by CAP inclusion, respectively (FM-30, FM-25, FM-20, FM-15, FM-10). The largemouth bass (110.0 ± 1.0 g) were fed one of the six diets for 8 weeks. The groups of FM-30, FM-25 and FM-20 showed the similar weight gain (WG) and feed conversion ratio (FCR) to the control (P > 0.05), while the WG of FM-10 group was decreased by 15.9%, and FCR increased by 0.12 when compared to the control (P 0.05). In conclusion, CAP could replace 150 g/kg fishmeal in diet (350 g/kg fishmeal) without adverse effects on growth, feed utilization and intestinal histology of largemouth bass.

Spinal muscular atrophy (SMA) is a rare neuromuscular condition, characterized by loss of motor neurons as a result of a mutation in the survival motor neuron gene. This results in muscle wasting and in the most common and severe type, death before 24 months. Over the recent years there has been a dynamic shift in the therapeutic options for these patients involving both clinical trials in genetic modifying therapies to indirectly improve the survival motor neuron protein level and hence strength, muscle promotor therapies, up/down regulation of modifier genes and more recently gene therapy to replace the mutated survival motor neuron gene. This review addresses the pathogenesis of SMA and the resultant therapeutic approaches as well as the current state in clinical trials and future development.

The objective of this study was to describe and classify common variations and compensation mechanisms in the sagittal alignment of the spine with lumbar degenerative disease.A total of 230 patients over 18 years old who underwent whole-spine X-rays to evaluate lower back pain were enrolled in this study. C7 slope, pelvic tilt (PT), sacral slope (SS), pelvic incidence (PI), thoracic kyphosis (TK), lumbar lordosis (LL), cervical lordosis (CL), thoracolumbar kyphosis (TLK), and sagittal vertical axis (SVA) were measured. Patients were divided into Group A (balance without compensation), B (balance with compensation), C (unbalance with compensation), and D (unbalance without compensation) according to spinopelvic balance and thoracic compensation.Group A had the largest LL, smallest PT, largest SS, and best clinical parameters of the four groups (p 0.001, p 0.001, p 0.001, p 0.001). The age increased gradually from Group B to Group D. Group B had an increased TK compared with Group A (p 0.001). Group C had an increased TK compared with Group A (p 0.001). Group D had an increased C7 slope compared with Group A (p = 0.022).This classification is shown four different regional and global alignments of the spine. Compensation took place to keep the balance of the spine. Classification types were consistent with age, compensation abilities, and clinical parameters. This classification potentially represents a valuable tool for comprehensive analysis of lumbar degenerative before surgical treatment considering sagittal balance.

The authors have requested that this preprint be removed from Research Square.

Abstract. Background: Data are scarce on assessing the impact of the COVID-19 pandemic on young people. Aim: To examine changes in crisis text patterns in the United States during the pandemic compared to the prepandemic period. Method: Nonintrusive data from a national digital crisis texting platform were analyzed using an interrupted time series design. Poisson regression with repeated-measures examined help-seeking patterns for stress, anxiety, depression, suicidal thoughts, and other mental health concerns in the pandemic (March 13 to July 20, 2020) compared to the prepandemic period (March 13 to July 20, 2019). Results: An abrupt increase in national crisis response texts occurred during the pandemic for stress and anxiety, substance abuse, bereavement, isolation, and abuse compared to the prepandemic period. Similar trends of excess texts for isolation and abuse were reported among children (relative risk [RR]abuse: 1.16, CI: 1.03, 1.31; RRisolation: 1.15, CI: 1.09, 1.21) and adolescents (RRabuse: 1.17, CI: 1.11, 1.24; RRisolation: 1.08, CI: 1.05, 1.11), bereavement among Black (RR: 1.31, CI: 1.12, 1.54) and Hispanic (RR: 1.28, CI: 1.10, 1.49) texters, and isolation and bereavement in female (RRisolation: 1.09, CI: 1.06, 1.11; RRbereavement: 1.21, CI: 1.13, 1.28) or nonconforming youth (RRisolation: 1.19, CI: 1.08, 1.32; RRbereavement: 1.50, CI: 1.08, 2.09) texters. Conversely, the risks of reporting bullying, depression, relationship issues, and suicidal thoughts as reasons for texting were significantly lower during COVID-19. Limitations: Results may underestimate crisis support-seeking in some groups because demographic data were not captured on all texters. Conclusion: Findings illuminated the real-time crisis response of young people across the United States and can inform more responsive interventions to alleviate the mental health consequences brought on by the COVID-19 pandemic.

The Onset fluency disorder is termed as stuttering or stammering, which is one of the most addressed disorder. There are numerous cause and stages of the stuttering, most of adolescent who run into this disorder will possesses either PWS or Dysfluency. These neuro cognitive disorders includes brain stimulation supported with significant research on brain and cognitive augmentation recommended and prescribed for the healthy adults and for the patients who suffered from neurological or psychiatric diseases. Number of sensing systems, for an instance functional near infrared spectroscopy (FNIRS) has been utilized in a significant manner to ascertain speech fluency and other related motor disabilities. In principle, FNIRS operated by quantifying hemoglobin-concentration changes in the brain based on optical intensity measurements, measuring the same hemodynamic changes. The said FNIRS provisioned to deliver as a neuro-imaging brain image interface (BCI) functioned to measure neuronal activities, significantly brain cortex considering neuro-vascular coupling through uniformly distributed opto-electronic devices. The dataset generated by the FNIRS confirmed the mapped reflection of the behavior of the brain depending upon the actions performed by the participants. Depending upon the disorder and severity, the placement of the optodes and sensitivity of the treatment or the module will vary. To boost it up a little bit, the simulation sessions will be conducted in a regular interval and the data which is being processed or collected through each sessions will be imparted onto the compute module as a prepossessed data to increase the scalability and reliability of the module.

Chronic inflammation caused by persistent infections and metabolic disorders is thought to contribute to the increased cancer risk and the accelerated cancer progression. Oppositely, acute inflammation induced by bacteria-based vaccines or that is occurring after cancer selectively inhibits cancer progression and metastasis. However, the interaction between inflammation and cancer may be more complex than the current explanations for the relationship between chronic and acute inflammation and cancer. In this review, we described the impact of inflammation on cancer on the basis of three perspectives, including inflammation with different durations (chronic and acute inflammation), different scopes (systemic and local inflammation) and different occurrence sequences (inflammation occurring after and before cancer). In addition, we also introduced bacteria/virus-based cancer immunotherapies. We perceive that inflammation may be a double-edged sword with cancer-promoting and cancer-suppressing functions in certain cases. We expect to further improve the understanding of the relationship between inflammation and cancer and provide a theoretical basis for further research on their complex interaction.

Study design Retrospective cohort study Introduction Service members who have sustained traumatic amputations are typically young and otherwise healthy. Beyond standard care, these individuals desire long, highly active, and relatively pain-free lifestyle, whether that is returning to active duty or transitioning to civilian life. Development of overuse musculoskeletal conditions could have a significant influence on quality of life for Service members with traumatic upper limb amputation. Purpose of the study Compare one-year incidence of overuse musculoskeletal injuries in Service members with different levels of combat-related upper limb amputation to Service members with minor combat-related upper limb injuries. Methods Service members with deployment-related upper limb injury (N = 519), 148 major upper limb amputation (55 with amputation at or above elbow, 93 with amputation below elbow) and 371 minor upper limb injury were included in the study. Outcomes of interest clinical diagnosis codes associated with overuse conditions of the upper limb, neck and upper back, lower limb, low back pain, and all regions combined, one year before and one year after injury. Results Overall, the one-year incidence of developing at least one musculoskeletal overuse condition after upper limb amputation was between 60% and 65%. Service members with upper limb amputations were 2.7 to 4.7 times more likely to develop an overuse upper limb condition, 3.6 to 3.8 times more likely to develop a neck and upper back condition, 2.8 to 4.4 times more likely to develop a lower limb condition, and 3.3 to 3.9 times more likely to develop low back pain as compared those who sustained minor combat-related injuries. No significant differences in the odds of developing a musculoskeletal condition was found between the above elbow and below elbow amputation groups. Conclusions Incidence of secondary overuse conditions is elevated in Service members with upper limb amputation and warrants focused research efforts toward preventative and rehabilitative interventions.

Traumatic optic neuropathy can have varying presentations. Blunt focal trauma can lead to optic nerve avulsion with underlying retinal findings. A case of partial optic nerve avulsion after finger poke injury leading to focal retinal ischemia is reported.Visual acuity, fundus photography with fluorescein angiography, and spectral-domain optical coherence tomography were performed to document the findings in a 16-year-old man who presented after a finger poke injury to the left orbit during a water polo match.On initial presentation, examination revealed decreased visual acuity with a fixed left pupil and afferent pupillary defect by reverse. On slit-lamp examination of the left eye, a hyphema was present. Dilated fundus examination revealed layering vitreous hemorrhage over the posterior pole and an avulsed vitreous base. On follow-up, a gap temporal to the optic nerve head consistent with a partial optic nerve avulsion was noted once the vitreous hemorrhage cleared. Multimodal imaging revealed retinal ischemia temporal to the disc on fluorescein angiography with corresponding changes in the inner retinal layers and retinal nerve fiber layer using spectral-domain optical coherence tomography.Clinicians should have a high suspicion for optic nerve avulsion if a patient presents with new vitreous hemorrhage and afferent pupillary defect after a finger-poke injury. Optic nerve avulsion injury can cause retinal ischemia, likely because of interruption of retinal blood flow as a result of nerve shearing injury. Multimodal imaging can reveal focal retinal injury and aid in proper diagnosis and follow-up.

PURPOSE To report a case of paracentral acute middle maculopathy (PAMM) in an otherwise healthy young, multiparous woman in her second trimester of pregnancy. METHODS Case report RESULTS:: A 38-year-old woman in her twentieth week of pregnancy presented with a four-day history of an acute paracentral scotoma in her left eye. Fundoscopic examination of the left eye was significant for a white-gray lesion inferonasal to the fovea which corresponded with spectral domain-optical coherence tomography (SD-OCT) hyperreflectivity at the outer plexiform layer-inner nuclear layer junction and optical coherence tomography angiography (OCTA) non-perfusion. A diagnosis of paracentral acute middle maculopathy was made. The patient was sent for a hypercoagulability work-up that revealed elevated factor VIII activity, which has been associated with increased risk of complications during pregnancy. CONCLUSION PAMM in pregnancy may be secondary to an underlying hypercoaguable condition. We recommend systemic evaluation and referral to a high-risk pregnancy specialist if PAMM is diagnosed during pregnancy. Additionally, OCTA in PAMM may demonstrate reperfusion of the affected vessels.