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Purpose: To describe and analyze characteristics and trends of pediatric ocular trauma during 2011-2020., Methods: Retrospective descriptive study. Data were collected on all pediatric ocular trauma cases that presented to a Rambam Health Care Campus during 2011-2020. Data included age, gender, visual acuity, diagnosis, injury mechanism and surgical repair., Results: Median BCVA at presentation was 0.96 (logMAR). Males and non-adolescent males specifically were the most prominent groups (70.6% and 44.7%, respectively). The ratio of ocular trauma cases to total pediatric emergency department (ED) visits was stable during 2011-2020 ( p  = 0.714) regardless of gender ( p  = 0.832 and p  = 0.545 for boys and girls, respectively). The leading causes were partial thickness eyelid laceration, periorbital hematoma, and extraocular muscle contusion, all of which were stable over the study period ( p  = 0.678, p  = 0.203 and p  = 0.398, respectively). Falls and children play were the most common mechanisms (25.8% and 18.4%, respectively), but differed between age groups. Most patients did not require consecutive operation and were treated conservatively ( p  < 0.01)., Conclusion: Pediatric ocular injuries to pediatric ED visits ratio remained stable during 2011-2020, regardless of gender. Non-adolescent males accounted for nearly half of all cases, with different mechanisms for each age group. Consecutive surgery was rarely necessary., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

(1) Background: The mechanism responsible for stroke in patients younger than 50 often remains unknown. This study was designed to assess whether high-resolution intracranial vessel wall MR imaging (icVWI) may be instrumental in determining stroke cause. (2) Methods: Young stroke patients with and without an identified cause of stroke despite an exhaustive investigation were prospectively included. Patients who underwent icVWI were compared to those who did not. We next compared patients with and without intracranial vulnerable plaques on icVWI. (3) Results: Overall, 47 young stroke patients were identified over the span of 2 years and included in this study. Of those, 20 (42%) underwent intracranial icVWI. Cancer prevalence was higher among patients who did not have an icVWI study (19% vs. 0% p = 0.042) but there were no other significant differences between patients who had an icVWI study and those who did not have an icVWI. Among patients who had an icVWI, 11 (55%) had vulnerable plaques and the remaining nine studies were negative. Patients with positive icVWI scans had significantly higher stroke severity at admission (mean ± SD NIHSS score 5.5 ± 3.5 vs. 1.7 ± 2.3, p = 0.012). Patients with positive icVWI scans were more often treated with antiplatelets upon discharge (100% vs. 67%, p = 0.038). (4) Conclusions: icVWI can add significant information relevant to stroke pathogenesis and secondary prevention among young stroke patients with a negative exhaustive diagnostic workup.

Background: The mechanism responsible for stroke in patients with embolic stroke of unknown source (ESUS) often remains unknown despite extensive investigations. We aimed to test whether high-resolution intracranial vessel wall MR imaging (icVWI) can add to the diagnostic yield in these patients., Patients and Methods: Patients with ESUS were prospectively included into an ongoing registry. Patients that underwent icVWI as part of their diagnostic workup were compared to those that did not have an icVWI. Patients with icVWI positive for intracranial vulnerable plaques were than compared to those without evidence of plaque vulnerability on VWI., Results: A total of 179 patients with ESUS were included and 48 of them (27%) underwent icVWI. Patients that had an icVWI scan were significantly younger, had lower rates of ischemic heart disease and prior disability as well as significantly lower stroke severity. On regression analysis the only factor that remained associated with not obtaining an icVWI scan was increasing age (Odds ratio [OR] 0.97/year, 95% confidence intervals [CI] 0.95-0.97). Among patients that had an icVWI scan 28 (58%) had evidence of plaque enhancement on VWI in the same distribution of the stroke and the remaining 20 studies were negative. The relative proportion of stroke presumed to be secondary to intracranial non-stenotic atheromatous disease increased from 15% in patients without icVWI scans to 58% among patients with icVWI scans (p = 0.001). On regression analysis the only factor that was associated with vulnerable plaques on icVWI was smoking (OR 11.05 95% CI 1.88-65.17)., Conclusions: icVWI can add significant information relevant to stroke pathogenesis and treatment in patients with ESUS and a negative initial exhaustive diagnostic workup., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background Cancer is associated with an increased risk of acute ischemic stroke, including large vessel occlusions. Whether cancer status affects outcomes in patients with large vessel occlusions that undergo endovascular thrombectomy remains unknown. Methods and Results All consecutive patients undergoing endovascular thrombectomy for large vessel occlusions were recruited into a prospective ongoing multicenter database, and the data were retrospectively analyzed. Patients with active cancer were compared with patients with cancer in remission. Association of cancer status with 90-day functional outcome and mortality were calculated in multivariable analyses. We identified 154 patients with cancer and large vessel occlusions that underwent endovascular thrombectomy (mean age, 74±11; 43% men; median National Institutes of Health Stroke Scale 15). Of the included patients, 70 (46%) had a remote history of cancer or cancer in remission, and 84 (54%) had active disease. Outcome data at 90 days poststroke were available for 138 patients (90%) and was classified as favorable in 53 (38%). Patients with active cancer were younger and more often smoked but did not significantly differ from those without malignancy in other risk factors, stroke severity, stroke subtype, or procedural variables. Favorable outcome rates among patients with active cancer did not significantly differ compared with those seen in patients without active cancer, but mortality rates were significantly higher among patients with active cancer on univariate and multivariable analyses. Conclusions Our study suggests that endovascular thrombectomy is safe and efficacious in patients with history of malignancy as well as in those with active cancer at the time of stroke onset, although mortality rates are higher among patients with active cancer.

Background: We report a rare case of ipsilateral multiple cranial neuropathy and ipsilateral lymphadenopathy following mRNA-COVID-19 vaccination., Case Presentation: A 41-year-old male visited our emergency room complaining of dysphagia and hoarseness that started a week after receiving COVID19 mRNA vaccination (in his right arm). During his hospitalization, he also complained of right side hearing loss and diplopia. Neurological examination depicted a right IV nerve palsy, ipsilateral facial paresthesia and peripheral facial paresis. Otorinolaryngological examination revealed right vocal cord paralysis. A brain magnetic resonance imaging showed enhancement of the right VII and VIII cranial nerves in the auditory canal. The lumbar puncture revealed increased protein concentration and lymphocytic pleocytosis in the cerebrospinal fluid (CSF). Additionally, a neck computed tomography (CT) scan showed a swollen right supraclavicular lymph node. We hypothesize that the ipsilateral cranial neuropathies of IV, VI, VII, VIII and X, associated with cervical lymphadenopathy, was possible caused by a post-vaccination immune-mediated reaction. The patient was treated with a 5-day course of intravenous methylprednisolone (1000 mg/day), and a gradual improvement was observed., Conclusions: Similarly, to other vaccines, it is possibly that also mRNA vaccines may act as triggers of non-specific autoimmune neurological syndromes., (© 2022. The Author(s).)

Aims: The objective of this paper is to systematically review the literature on drug-drug interactions with warfarin, with a focus on patient-important clinical outcomes., Methods: MEDLINE, EMBASE and the International Pharmaceutical Abstract (IPA) databases were searched from January 2004 to August 2019. We included studies describing drug-drug interactions between warfarin and other drugs. Screening and data extraction were conducted independently and in duplicate. We synthesized pooled odds ratios (OR) with 95% confidence intervals (CIs), comparing warfarin plus another medication to warfarin alone. We assessed the risk of bias at the study level and evaluated the overall certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach., Results: Of 42 013 citations identified, a total of 72 studies reporting on 3 735 775 patients were considered eligible, including 11 randomized clinical trials and 61 observational studies. Increased risk of clinically relevant bleeding when added to warfarin therapy was observed for antiplatelet (AP) regimens (OR = 1.74; 95% CI 1.56-1.94), many antimicrobials (OR = 1.63; 95% CI 1.45-1.83), NSAIDs including COX-2 NSAIDs (OR = 1.83; 95% CI 1.29-2.59), SSRIs (OR = 1.62; 95% CI 1.42-1.85), mirtazapine (OR = 1.75; 95% CI 1.30-2.36), loop diuretics (OR = 1.92; 95% CI 1.29-2.86) among others. We found a protective effect of proton pump inhibitors (PPIs) against warfarin-related gastrointestinal (GI) bleeding (OR = 0.69; 95% CI 0.64-0.73). No significant effect on thromboembolic events or mortality of any drug group used with warfarin was found, including single or dual AP regimens., Conclusions: This review found low to moderate certainty evidence supporting the interaction between warfarin and a small group of medications, which result in increased bleeding risk. PPIs are associated with reduced hospitalization for upper GI bleeding for patients taking warfarin. Further studies are required to better understand drug-drug interactions leading to thromboembolic outcomes or death., (© 2021 British Pharmacological Society.)

The melanocortin pathway has been implicated in both metabolism and sexual function. When the melanocortin 4 receptor (MC4R) is knocked out globally, male mice display obesity, low sexual desire, and copulatory difficulties; however, it is unclear whether these phenotypes are interdependent. To elucidate the neuronal circuitry involved in sexual dysfunction in MC4R knockouts, we re-expressed the MC4R in these mice exclusively on Sim1 neurons (tbMC4R Sim1 mice) or on a subset of Sim1 neurons, namely oxytocin neurons (tbMC4R oxt mice). The groups were matched at young ages to control for the effects of obesity. Interestingly, young MC4R null mice had no deficits in sexual motivation or erectile function. However, MC4R null mice were found to have an increased latency to reach ejaculation compared to control mice, which was restored in both tbMC4R Sim1 and tbMC4R oxt mice. These results indicate that melanocortin signaling via the MC4R on oxytocin neurons is important for normal ejaculation independent of the male's metabolic health.

The role of social support in assisting youth in developed countries cope with their HIV diagnosis has been examined through a vast body of research; yet, there remains a gap in research around the effects of social support among youth living in sub-Saharan African countries including Kenya. This study aimed to examine the role of social support among Kenyan youth living with HIV, specifically with regard to the variations in influences of this social support. We conducted semi-structured focus group discussions with youth (ages 18 to 27) living in the informal urban settlement of Kibera in Nairobi, Kenya ( n = 53). Data analysis followed a phenomenological inquiry framework, and seven major categories of perceived social support influences were identified: (1) linkage to services, (2) antiretroviral (ARV) adherence, (3) self-acceptance of HIV status, (4) healthy and positive living, (5) understanding of what it means to be living with HIV, (6) HIV status disclosure, and (7) family and occupational strengthening. The findings from this study suggest that Kenyan youth living with HIV can benefit from social support in a multitude of ways and can occur across several socio-ecological levels. Future research should further examine these influences, specifically regarding intervention development across socio-ecological levels.

Background: Transplantation of mesenchymal stem cells has created enormous opportunities as a potential treatment for various diseases including neurodegenerative diseases. Given current techniques, such as Hoechst labeling, have safety and leakage issues, our study focused, as a proof-of-concept, on a new dendrimer-based technique for labeling these stem cells to ensure their efficacy and safety following transplantation into the brain of a healthy mice., Methods and Results: The bone marrow-derived mesenchymal stem cells (BM-MSCs) were labeled using polyaminoamine (PAMAM) dendrimers following which their stemness based on their proliferation and differentiation ability were analyzed by gold standard methods. These labeled BM-MSCs were transplanted into the striatum of C57BL/6J mice and were tracked using in vivo imaging system (IVIS) and analyzed using tissue imaging, 2 weeks after transplantation. Our results showed that the dendrimer-labeled BM-MSCs were able to successfully maintain their stemness and were tracked in vivo following transplantation. Unlike Hoechst, we did not find the dendrimers to be leaking out of the cells and were very specific to the cells that up took the dendrimers. Moreover, no adverse events were found in the transplanted animals proving that this is a safer method., Conclusions: Labeling BM-MSCs using fluorescently tagged PAMAM dendrimers can be used as a potentially safe and efficient method for labeling cells, particularly stem cells, in vitro and in vivo following transplantation in rodents.

Social support helps youth manage psychosocial stress. Though many studies have investigated the role of social support in helping youth in developed countries cope with their HIV status, such research is lacking among youth living in sub-Saharan African countries, including Kenya. The importance of research on youth living with HIV in Kenya is enhanced given young people's unique developmental stages and the HIV prevalence rate of 8.8% among Kenyans aged 25 to 29 years. To gain further insight, qualitative focus group interviews were conducted with 53 youth aged 18 to 27 years who lived in the informal urban settlement of Kibera in Nairobi, Kenya. A phenomenological approach was used to analyse the data from which four major types of social support were identified: 1) emotional; 2) informational; 3) appraisal; and 4) instrumental. Within each of these overarching themes more specific sub-themes were identified. The youth also reported receiving social support from eight main sources: 1) family; 2) friends; 3) clinicians and clinical services; 4) counsellors; 5) support groups; 6) religious sources; 7) partners; and 8) other. These findings suggest that various forms of social support, provided by diverse sources, which may fall outside of those commonly involved in interventions, can help youth living with HIV cope with their diagnosis and promote healthy lifestyles. Future research should investigate the roles and interactions of different types and sources of support, specifically as they relate to interventions aiming to ameliorate the experiences of youth newly diagnosed with HIV.

Aims: To investigate the correlation of beta-subunit of human chorionic gonadotrophin (hCG beta) expression by cervical carcinomas with measures of tumour apoptosis., Methods and Results: Eighty-nine cervical carcinoma patients' samples were subject to hCG beta immunohistochemistry and scored with respect to intensity of immunopositivity and percentage of positive cells. Apoptosis was evaluated by three independent parameters: morphological characteristics [haematoxylin and eosin (H&E)], terminal deoxynucleotidyl transferase biotin-dUTP nick end labelling (TUNEL) and poly (ADP-ribose) polymerase (PARP) immunopositivity. Of the 12 adenocarcinomas, only one (8%) was hCG beta+. However, 87% (61/70) of the squamous cell and 100% (7/7) of adenosquamous cell carcinomas were hCG beta+. hCG beta reactivity and intensity was predominantly confined to peripheral tumour cells at the stromal-epithelial interface. Correlation analysis showed that H&E and PARP apoptotic immunopositivity negatively correlated with hCG beta expression (P < 0.001 and P = 0.028 respectively), whereas TUNEL did not (P = 0.12). However, immunopositivity for apoptotic cells by TUNEL was significantly less in tumours where hCG beta expression was greater (scoring >or= 6) and vice versa. hCG beta immunopositivity was also observed in newly formed blood vessels, as well as tumour cells within lymphatic vessels. When tumour vascularization was taken into account, samples with noted vascularization positively correlated with hCG beta scoring., Conclusions: hCG beta expression correlates with reduced tumour cell apoptosis and may be involved in tumour vascularization and dissemination.

The fatty acid composition of the tunicate Botryllus schlosseri and of two bacterial strains found within the tunicate, namely Vibrio parahaemolyticus and of an associated but previously unreported gram positive cocci were studied. The polyunsaturated fatty acids 6,9,12-octadecatrienoic acid, 5,8,11,14,17-eicosapentaenoic acid, and 4,7,10,13,16,19-docosahexaenoic acid were particularly abundant in B. schlosseri and were not detected in the two bacterial strains found in the tunicate. The iso/anteiso pair, 13-methyltetradecanoic acid and 12-methyltetradecanoic acid, were the principal fatty acids in the gram positive cocci, and the 9- and 11-hexadecenoic acids were particularly abundant in V. parahaemolyticus. The diunsaturated fatty acid 9,12-octadecadienoic acid was also shown to be present in V. parahaemolyticus. The fatty acid composition of a third bacterial strain, characterized as either a Pseudomonas or an Alteromonas species, and shown to be present only in the sea water from the Black Sea and not in B. schlosseri, is also reported. This is the first investigation on fatty acids from Black Sea bacteria.

The phospholipid fatty acid composition of the Calcarean sponge Leucosolenia canariensis was studied, and no delta 5,9 fatty acids were detected. These results are in contrast to the phospholipids from sponges belonging to the class Demospongiae where delta 5,9 fatty acids are predominant. Odd branched-chain fatty acids between 17 and 19 carbons accounted for 26% of the total fatty acids of L. canariensis, while straight-chain fatty acids between 16 and 22 carbons accounted for 61% of the total fatty acid composition. The sterol composition of L. canariensis is also reported, and only delta 5,7,22 sterols were observed.

The phospholipid fatty acid composition of the Caribbean sponge Amphimedon viridis was studied, revealing the presence of the previously unreported substances 5,13-nonadecadienoic acid, 4-nonadecenoic acid, and 15-heneicosenoic acid. In A. viridis the very long-chain 5,9,23-nonacosatrienoic acid and 5,9,23-tricosatrienoic acid predominated in the mixture. The fatty acid composition of the sponge Desmapsamma anchorata was revised and 62 phospholipid fatty acids were characterized. The rare 8,13-octadecadienoic acid and 18-tetracosenoic acid were also characterized in the mixture. The two possible stereochemical isomers of 7-methyl-6-hexadecenoic acid, i.e., 7-methyl-6(Z)-hexadecenoic acid and the 7-methyl-6(E)-hexadecenoic acid were identified in both sponges, but D. anchorata had larger amounts. This is the first time that both stereoisomers have been identified in a sponge. The previously reported 7-methyl-8-hexadecenoic acid was not found in D. anchorata. Unprecedented aldehydes, comprising 15-and 17-docosenal, were also identified in the sponges.

The novel alpha-hydroxy fatty acids 2-hydroxy-13-docosenoic acid [1a], 2-hydroxy-14-tricosenoic acid [2a], and 2-hydroxy-15-tetracosenoic acid [3a] were identified in the Caribbean urchin, Tripneustes esculentus. The double-bond positions of the novel alpha-hydroxy fatty acids were determined by derivatization with dimethyl disulfide and shown to correlate with the corresponding non-hydroxylated mono-unsaturated fatty acids, 13-docosenoic acid, 14-tricosenoic acid, and 15-tetracosenoic acid also present in T. esculentus. The total fatty acid composition of the urchins is also reported where cis-5-olefinic fatty acids such as 5,9-octadecadienoic acid and 5,11-eicosadienoic acid were found to predominate in the mixture. Cholesterol was the predominant sterol in T. esculentus.

The previously unreported 27-methyl-5,9-octacosadienoic acid [1] and 26-methyl-5,9-octacosadienoic acid [2] were identified in the phospholipids of the Caribbean sponges Chondrosia remiformis and Myrmekioderma styx. Both sponges also contain the novel 15-methyl-5,9-hexadecadienoic acid [3] in their phospholipids. These results extend the possible chain lengths in delta 5,9 iso/anteiso fatty acids in sponge phospholipids from C17 to C29.

The long-chain fatty acids (5E,9Z)-6-bromo-5,9-heptacosadienoic acid [2a], (5E,9Z)-6-bromo-5,9-octacosadienoic [3a], (Z)-19-heptacosenoic acid [4], and the novel aldehydes 17-pentacosenal [5] and 17-hexacosenal [6] were identified in the phospholipids (mainly phosphatidylethanolamine and phosphatidylcholine) of the sponge Petrosia sp. Structural elucidation was accomplished by means of mass spectrometry and chemical transformations, including deuteration with Wilkinson's catalyst. The dimethyldisulfide derivatization of delta(5.9) fatty acids is also presented.

1. The phospholipid fatty acid compositions of the sponges Ircinia strobilina, Ircinia felix, Ircinia campana, Ircinia sp., Spongia tubulifera and Dysidea etherea were studied, revealing the presence, besides other common fatty acids, of considerable amounts (2-5%) of the novel 23-methyl-5,9-tetracosadienoic acid (1). 2. The demospongic acids 5,9-tetracosadienoic acid, 23-methyl-5,9-tetracosadienoic acid (1), and 5,9-pentacosadienoic acid, were particularly abundant in sponges of the genus Ircinia, in contrast to the most common 5,9-hexacosadienoic acid found in other species. These findings are discussed in terms of the taxonomy of the Dictyoceratida. 3. The complete characterization of the novel phospholipid fatty acid 23-methyl-5,9-tetracosadienoic acid (1) is presented.

The first trans fatty acids from a sponge have been isolated from Plakortis halichondroides. The sponge was shown to contain the iso acids (5E,9E)-19-methyl-5,9-eicosadienoic, (5E,9E)-20-methyl-5,9-heneicosadienoic and (5E,9E)-21-methyl-5,9-docosadienoic acid, as well as the anteiso acids (5E,9E)-19-methyl-5,9-heneicosadienoic and (5E,9E)-20-methyl-5,9-docosadienoic acid together with the straight chain (5E,9E)-5,9-docosadienoic acid. The acids were shown by gas chromatography, Fourier transform infrared and 13C nuclear magnetic resonance to contain the trans configuration. An eicosadienoic acid, namely (6E,14E)-6,14-eicosadienoic acid, and 12-methyl-5-octadecenoic acid were also identified in a sponge for the first time. The fatty acids were shown to be the principal constituents of phosphatidylethanolamine and phosphatidylcholine. No sterols were found in the sponge. The results presented in this work should be helpful in taxonomy of Homoscleromorpha.

The phospholipid fatty acids from the sponge Spheciospongia cuspidifera were studied revealing the presence of the rare 10-octadecenoic acid (10-18:1) and a new 2-methoxyhexadecenoic acid. The phospholipid fatty acids from Thalysias juniperina were also studied revealing the presence of the hitherto unreported 18-hexacosenoic acid (18-26:1). These results tend to indicate that the biosynthetic pathway from 10-18:1 to 18-26:1 may be operative in nature. The phospholipid mixture from the sponges was also analyzed by 31P-NMR and shown to mainly consist of phosphatidylethanolamine, phosphatidylserine, phosphatidylinositol, and phosphatidylglycerol. Phosphatidylcholine was not found in the sponges analyzed in this work.

The alpha-hydroxy fatty acids 2-hydroxy-eicosanoic (1) acid, 2-hydroxyheneicosanoic (2) acid, 2-hydroxydocosanoic (3) acid, 2-hydroxytetracosanoic (4) acid, 2-hydroxy-23-methyl-tetracosanoic acid and 2-hydroxypentacosanoic (5) acid were isolated from the Caribbean sponges Verongula gigantea and Aplysina archeri. The very long chain fatty acids 5,9-nonacosadienoic acid (29:2) and 5,9,23-tricontatrienoic acid (30:3) were also identified together with the iso-prenoid fatty acid 3,7,11,15-tetramethylhexadecanoic (phytanic) acid that seems to be common in the Aplysinidae. A. archeri contained an extremely long chain fatty acid tentatively characterized as dotricontaenoic (32:1) acid. These acids were found to occur in phosphatidylserine, phosphatidylinositol, phosphatidylethanolamine, phosphatidylcholine and traces of phosphatidylglycerol.