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Takotsubo cardiomyopathy is a reversible, stress-induced systolic abnormality of the left ventricular apex. 1 , 2 It can carry significant morbidity and mortality for patients, largely due to associated complications that can occur in the acute setting. While it is most commonly linked with acute emotional or physical stressors, it is now recognized that many acute medical illnesses can precipitate the syndrome. Severe acute hyponatremia (<120 mmol/L) should be considered as a possible causative condition for Takotsubo cardiomyopathy, however reports of its occurrence in the literature are exceedingly rare. 3-14 We present a case of a 73-year-old woman who was admitted for severe hyponatremia secondary to syndrome of inappropriate anti-diuretic hormone (SIADH) with a sodium level of 105 mmol/L and a concomitant diagnosis of Takotsubo cardiomyopathy, as well as a review of the epidemiology, pathophysiology, clinical features, diagnosis, treatment and clinical outcomes of Takotsubo cardiomyopathy., Competing Interests: Declaration of competing interest The authors whose names are listed above certify that they have no affiliation with any organization with any financial interest or non-financial interest in the subject matter or materials discussed in the manuscript., (Copyright © 2024 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.)

Introduction: It is critical to develop and implement lab-based computer experiments that simulate real-world tasks in order to characterize operational requirements and challenges or identify potential solutions. Achieving a high degree of laboratory control, operational generalizability, and ease-of-use for a task is challenging, often leading to the development of tasks that can satisfy some facets but not all. This can result in insufficient solutions that leave real-world stakeholders with unsolved problems., Materials and Methods: This issue is addressed using a customized passive sonar simulator application that provides extensive researcher control over the design and manipulation of a sonar task; a visual appearance and cognitive demand similar to a true submarine-based sonar task; and a convenient and short training routine for sonar novices. The task requires participants to watch for multiple signal sources of varying appearance and salience and subsequently classify these signals into their respective categories., Results: The current study investigated the effects of stimulus signal strength and signal density on sonar task performance-including metrics of classification accuracy, classification confidence, and response times-finding an interaction between signal density and signal strength that resulted in greater performance errors with high signal density at the weakest signal strength., Conclusions: The lab-based sonar application provides new possibilities for research, not limited to signal intensity and signal density but also through the manipulation of parameters such as the number of unique targets, target appearance, and task duration. This application may illuminate the operational demands that each of these factors may have on operator behavior within the dynamic tasks., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2024. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

Background: Multiple lines of evidence show that the human amygdala is part of a neural network important for perception of emotion from environmental stimuli, including for processing of intrinsic attractiveness/"goodness" or averseness/"badness," i.e., affective valence., Objective/hypothesis: With this in mind, we investigated the effect of electrical brain stimulation of the human amygdala on perception of affective valence of images taken from the International Affective Picture Set (IAPS)., Methods: Using intracranial electrodes in patients with epilepsy, we first obtained event-related potentials (ERPs) in eight patients as they viewed IAPS images of varying affective valence. Next, in a further cohort of 10 patients (five female and five male), we measured the effect of 50 Hz electrical stimulation of the left amygdala on perception of affective valence from IAPS images., Results: We recorded distinct ERPs from the left amygdala and found significant differences in the responses between positively and negatively valenced stimuli ( p = 0.002), and between neutral and negatively valenced stimuli ( p = 0.017) 300-500 ms after stimulus onset. Next, we found that amygdala stimulation did not significantly affect how patients perceived valence for neutral images ( p = 0.58), whereas stimulation induced patients to report both positively ( p = 0.05) and negatively (< 0.01) valenced images as more neutral., Conclusion: These results render further evidence that the left amygdala participates in a neural network for perception of emotion from environmental stimuli. These findings support the idea that electrical stimulation disrupts this network and leads to partial disruption of perception of emotion. Harnessing this effect may have clinical implications in treatment of certain neuropsychiatric disorders using deep brain stimulation (DBS) and neuromodulation., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Bujarski, Song, Xie, Leeds, Kolankiewicz, Wozniak, Guillory, Aronson, Chang and Jobst.)

Background: DDX3X syndrome is a recently identified genetic disorder that accounts for 1-3% of cases of unexplained developmental delay and/or intellectual disability (ID) in females, and is associated with motor and language delays, and autism spectrum disorder (ASD). To date, the published phenotypic characterization of this syndrome has primarily relied on medical record review; in addition, the behavioral dimensions of the syndrome have not been fully explored., Methods: We carried out multi-day, prospective, detailed phenotyping of DDX3X syndrome in 14 females and 1 male, focusing on behavioral, psychological, and neurological measures. Three participants in this cohort were previously reported with limited phenotype information and were re-evaluated for this study. We compared results against population norms and contrasted phenotypes between individuals harboring either (1) protein-truncating variants or (2) missense variants or in-frame deletions., Results: Eighty percent (80%) of individuals met criteria for ID, 60% for ASD and 53% for attention-deficit/hyperactivity disorder (ADHD). Motor and language delays were common as were sensory processing abnormalities. The cohort included 5 missense, 3 intronic/splice-site, 2 nonsense, 2 frameshift, 2 in-frame deletions, and one initiation codon variant. Genotype-phenotype correlations indicated that, on average, missense variants/in-frame deletions were associated with more severe language, motor, and adaptive deficits in comparison to protein-truncating variants., Limitations: Sample size is modest, however, DDX3X syndrome is a rare and underdiagnosed disorder., Conclusion: This study, representing a first, prospective, detailed characterization of DDX3X syndrome, extends our understanding of the neurobehavioral phenotype. Gold-standard diagnostic approaches demonstrated high rates of ID, ASD, and ADHD. In addition, sensory deficits were observed to be a key part of the syndrome. Even with a modest sample, we observe evidence for genotype-phenotype correlations with missense variants/in-frame deletions generally associated with more severe phenotypes.

Background : Activity dependent neuroprotective protein (ADNP) syndrome is one of the most common single-gene causes of autism spectrum disorder (ASD) and intellectual disability, however, the phenotypes remain poorly described. Here we examine the sensory reactivity phenotype in children and adolescents with ADNP syndrome. Methods: Twenty-two individuals with ADNP syndrome received comprehensive clinical evaluations including standardized observations, caregiver interviews, and questionnaires to assess sensory reactivity symptoms. Relationships between sensory symptoms and age, sex, ASD, IQ, and adaptive behavior were examined. Genotype-phenotype correlations with the recurrent p.Tyr719* variant were also explored. Results: Sensory reactivity symptoms were observed and reported in all participants. A syndrome-specific phenotype was identified, characterized by high levels of sensory seeking across tactile, auditory, and visual domains. Tactile hyporeactivity, characterized by pain insensitivity, was reported in the majority of participants. Sensory symptoms were identified across individuals regardless of age, sex, IQ, adaptive ability, genetic variant, and most importantly, ASD status. No significant differences were identified between participants with and without the recurrent p.Tyr719* variant on any sensory measure. Conclusions: Sensory reactivity symptoms are a common clinical feature of ADNP syndrome. Quantifying sensory reactivity using existing standardized measures will enhance understanding of sensory reactivity in individuals with ADNP syndrome and will aid in clinical care. The sensory domain may also represent a promising target for treatment in clinical trials.

Thrombocytosis is defined as a platelet count greater than 400,000/mcL. We report the case of a patient who developed thrombocytosis after receiving ciprofloxacin and ceftriaxone therapy. A 73-year-old African-American female presented to the hospital with altered mental status attributed to sepsis and urinary tract infection. Patient was initiated on multiple empiric antibiotic therapy and was subsequently transitioned to ciprofloxacin and ceftriaxone at different times as definitive therapy for treatment of Escherichia coli bacteremia and Escherichia coli urinary tract infection. The patient developed thrombocytosis during and/or proximally to the administration of ciprofloxacin and ceftriaxone. A myeloproliferative source for the thrombocytosis was ruled out by the hematology/oncology team with a negative Janus kinase 2 V617F mutation assay result. In addition, other nondrug reactive sources of thrombocytosis (infection and anemia) were generally ruled out because the thrombocytosis was proximally linked with ciprofloxacin and ceftriaxone administration. The Naranjo Adverse Drug Reaction Probability Scale assigned a score of 5, indicating ciprofloxacin or ceftriaxone independently or in combination as a probable cause of thrombocytosis. This case report suggests that ciprofloxacin in combination with ceftriaxone (a beta-lactam antibiotic) may be a probable cause of thrombocytosis.

Background: Plasmacytomas are monoclonal proliferations of plasma cells that typically affect the intramedullary axial skeleton. Imaging findings of an extramedullary plasmacytoma on radiograph and computed tomography can be nonspecific and can resemble other entities such as lymphoma, metastases, chondrosarcomas, or giant cell tumors., Case Report: A 60-year-old female with a medical history of partial complex seizures, hypertension, diabetes, glaucoma, and hyperlipidemia presented with complaints of superficial abdominal pain associated with erythema and swelling for 3 weeks. Computed tomography of her abdomen at time of presentation revealed a 5.8 × 2.7-cm irregularly marginated soft-tissue density just below the umbilicus with an adjacent defect in the midline rectus abdominis. The final pathologic diagnosis was extramedullary plasmacytoma. Treatment during the next year included local radiation, systemic chemotherapy, and an autologous peripheral blood stem cell transplant. Three years after initial diagnosis, the patient presented to the emergency department, and testing revealed new plasmacytomas. The decision was made to proceed with palliative care., Conclusion: This case is a unique example of a patient with an extramedullary plasmacytoma with no diagnostic signs of multiple myeloma.

We examined differences in regional brain activation during tests of executive function in individuals with Hoarding Disorder (HD), Obsessive Compulsive Disorder (OCD), and healthy controls (HC) using functional magnetic resonance imaging (fMRI). Participants completed computerized versions of the Stroop and Go/No-Go task. We found that during the conflict monitoring and response inhibition condition in the Go/No-Go task, individuals with HD had significantly greater activity than controls in the anterior cingulate cortex (ACC) and right dorsolateral prefrontal cortex (DLPFC). HD also exhibited significantly greater right DLPFC activity than OCD. We also observed significant differences in activity between HD and HC and between HD and OCD in regions (ACC, anterior insula, orbitofrontal cortex, and striatum) involved in evaluating stimulus-response-reward associations, or the personal and task-relevant value of stimuli and behavioral responses to stimuli. These results support the hypothesis that individuals with HD have difficulty deciding on the value or task relevance of stimuli, and may perceive an abnormally high risk of negative feedback for difficult or erroneous cognitive behavior., Competing Interests: The authors report no conflict of interest., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Combining high-density scalp EEG recordings with a sensitive analog measure of STM's fidelity, we characterized the temporal dynamics of intentional ignoring and related those dynamics to the intrusion of task-irrelevant information. On each trial of the task, two study Gabors were briefly presented in succession. A green or red disc preceding each Gabor signified whether that Gabor should be remembered or ignored, respectively. With cue-stimulus intervals of 300, 600, or 900 msec presented in separate sessions, we found that the onset of posterior, prestimulus alpha oscillations varied with the length of the interval. Although stimulus onset time was entirely predictable, the longer the cue-stimulus interval, the earlier the increase in prestimulus alpha power. However, the alpha-band modulation was not simply locked to the cue offset. The temporal envelopes of posterior alpha-band modulation were strikingly similar for both cued attending and cued ignoring and differed only in magnitude. This similarity suggests that cued attending includes suppression of task-irrelevant, spatial processing. Supporting the view that alpha-band oscillations represent inhibition, our graded measure of recall revealed that, when the stimulus to be ignored appears second in the sequence, peristimulus alpha power predicted the degree to which that irrelevant stimulus distorted subsequent recall of the stimulus that was to be remembered. These results demonstrate that timely deployment of attention-related alpha-band oscillations can aid STM by filtering out task-irrelevant information.

Although currently there is a large body of research on the characteristics and treatment of sex offenders, very little research has been conducted to investigate the characteristics of sex offenders who have been adjudicated insane. This study included 42 patients at Napa State Hospital who were adjudicated not guilty by reason of insanity (NGRI) for a sex offense. The sample was further divided into offenders whose victims were children and those whose victims were adults. Data were collected with a structured chart review instrument. A large percentage of the sex offenders received a primary diagnosis of schizophrenia or schizoaffective disorder, and many had a comorbid substance use disorder. The high percentage of sex offenders in the current study with diagnosed schizophrenia or schizoaffective disorder may represent a previously unstudied subgroup of sex offenders. An alternative explanation is that the experts did not evaluate substance use and intoxication adequately, assess for malingering, or apply the proper legal standard for insanity.

The parallel processing of visual information was studied with penetrating microelectrode arrays. We studied the high-resolution visuotopic organization of cat primary visual cortex, and the encoding of simple visual stimuli by ensembles of ganglion cells in the isolated turtle retina. The high-resolution visuotopic organization of visual cortex is non-conformal. Regions of visual cortex separated by 400 mu may have receptive field centers that are separated by as much as 3 degrees, or they may superimpose. Ganglion cells are 'generalists', and are poor specifiers of the color of full field visual stimuli. Groups of 'luminosity' type ganglion cells can assist in the specification of stimulus color, but even individual 'chromatic' ganglion cells are not capable of quality color specification. These basic studies have relevance to the development of visual neuroprostheses based upon electrical stimulation of the retina and cortex.

The purpose of this paper is to describe a safe new technique for intraoperative identification of the site of cerebrospinal fluid rhinorrhea. Cerebrospinal fluid (CSF) rhinorrhea after intracranial or intranasal surgery is a known potential complication with significant morbidity and mortality. It is currently accepted that endoscopic intranasal management of CSF rhinorrhea is the preferred method of surgical repair, with higher success rates and less morbidity than intracranial surgical repair in selected cases. Accurate identification of the site of CSF leakage is necessary for a successful endoscopic surgical repair. Computer tomography (CT) with or without intrathecal contrast and preoperative nasal endoscopy are frequently used to preoperatively localize the site of the leak. Intrathecal fluorescein administered immediately before surgery has aided in the intraoperative identification of the site of CSF leak in 25-64% of patients undergoing endoscopic repair of CSF rhinorrhea in whom preoperative CT scanning and nasal endoscopy had not identified the site of CSF leak. Intrathecal fluorescein, however, has been associated with severe complications, such as lower extremity weakness, numbness, generalized seizures, opisthotonus, and cranial nerve deficits. We present three cases of CSF rhinorrhea in which fluorescein was applied intranasally during the endoscopic surgical repair. Ten percent fluorescein was applied to the nose with a cotton swab. Under endoscopic visualization the fluorescein changed its fluorescent color from amber/yellow to a dark green and was found streaming from high in the nasal cavity, which led to accurate identification of the site of the CSF leak.

We report the frequency and type of infectious ocular complications following orthotopic liver transplantation (OLT) and review diagnostic and therapeutic strategies. During the period September 1988 through November 1994, 684 patients underwent OLT at Mount Sinai Hospital (New York). Nine orthotopic liver transplant patients (1.3%) developed ocular infections: Candida albicans endophthalmitis (2), Aspergillus fumigatus endophthalmitis (1), cytomegalovirus retinitis (4), herpes simplex virus keratitis (1), and varicella-zoster virus panophthalmitis (1). The mean time from OLT to ocular symptoms was 42 days for patients with fungal infections and 128 days for patients with viral infections. Blurred vision was the commonest symptom (five of nine cases). The mean duration of follow-up was 2 years (range, 33 days to 5 years). Permanent loss of vision occurred in three patients, five had improvement in visual acuity, and one died of disseminated aspergillosis 33 days after OLT. Infectious ocular complications following OLT may occur as isolated events or with disseminated disease. Fungal infections occur earlier (mean, 42 days after OLT) than viral infections (mean, 4 months after OLT). The clinical presentation may be atypical; aggressive vitreoretinal procedures and serial examinations may be required to establish the diagnosis. Cytomegalovirus retinitis in orthotopic liver transplant patients may not require life-long maintenance therapy with antiviral agents.

Two larvae of Taenia solium (eg, Cysticercus cellulosae) were identified in the posterior vitreous attached to the optic nervehead of a 13-year-old Guatemalan girl. Preoperative evaluation showed the larvae to be viable. The vitreous showed a mild cellular reaction. The larvae were dissected off the optic nervehead and removed via a pars plana approach, without incident. To our knowledge, this is the first case report of cysticerci attached to the optic nervehead that were removed successfully by the pars plana approach. The patient was treated with a very short preoperative and postoperative course of corticosteroids. No inflammatory flare-ups or recurrence of the cysticercosis were found during the one-year follow-up period.

Visual evoked potentials (VEPs) and contrast sensitivity (CS) were studied in patients affected by maculopathy. VEP delays and CS reduction were demonstrated in each affected eye. In distinction to patients affected by multiple sclerosis (MS), in maculopathy patients VEP latency is independent of the orientation of the grating stimulus. It is proposed that stimulating with more than one pattern orientation is useful in the differential diagnostic use of VEPs.